=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578233375
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ME PIVOT HOLDINGS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2021
-----------------------------------------------------
Last Update Date | 09/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4015 GOVERNOR DR
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92122-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-458-9019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 S 5TH ST STE 2300
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55402-4223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-268-4286
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LEAD BILLING SPECIALIST
-----------------------------------------------------
Name | KAYLYNN MURPHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 763-268-4286
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------