=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194291302
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ME PIVOT HOLDINGS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2018
-----------------------------------------------------
Last Update Date | 01/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 PLAZA CIR UNIT 310
-----------------------------------------------------
City | SANTEE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29142-9630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-854-4888
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 S 5TH ST STE 2300
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55402-4223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KEN HALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 763-268-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------