Healthcare Provider Details

I. General information

NPI: 1740812981
Provider Name (Legal Business Name): ME PIVOT HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956A DAWSONVILLE HWY STE 302
GAINESVILLE GA
30501-2619
US

IV. Provider business mailing address

150 S 5TH ST STE 2300
MINNEAPOLIS MN
55402-4223
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-5552
  • Fax: 678-696-5905
Mailing address:
  • Phone: 763-268-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: KEN HALL
Title or Position: PRESIDENT
Credential:
Phone: 763-268-4000