Healthcare Provider Details

I. General information

NPI: 1023441714
Provider Name (Legal Business Name): TRI-COUNTY HEARING AID SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 CORPORATE DR STE 1
BEAVER DAM WI
53916-1281
US

IV. Provider business mailing address

140 CORPORATE DR STE 1
BEAVER DAM WI
53916-1281
US

V. Phone/Fax

Practice location:
  • Phone: 920-887-9658
  • Fax: 920-887-9655
Mailing address:
  • Phone: 920-887-9658
  • Fax: 920-887-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number1428-60
License Number StateWI

VIII. Authorized Official

Name: PAMELA BRAKER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 920-887-9658