Healthcare Provider Details

I. General information

NPI: 1902256282
Provider Name (Legal Business Name): HEARING ADVANTAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 06/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2234 NEVA RD
ANTIGO WI
54409-2910
US

IV. Provider business mailing address

181 S ANDERSON ST
RHINELANDER WI
54501-3448
US

V. Phone/Fax

Practice location:
  • Phone: 888-897-3711
  • Fax: 715-420-1686
Mailing address:
  • Phone: 888-897-3711
  • Fax: 715-420-1686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number1390060
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number1229060
License Number StateWI

VIII. Authorized Official

Name: JESSE KASTER
Title or Position: OWNER
Credential:
Phone: 715-362-3711