MEDICARE: ME PIVOT HOLDINGS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist

General Provider Information

NPI Number	:	1568938777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ME PIVOT HOLDINGS LLC

Provider Business Mailing Address
First Line	:	150 S 5TH ST STE 2300
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-4223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13313 OCEAN HWY # 17
Second Line	:
City	:	PAWLEYS ISLAND
State	:	SC
Zip	:	29585-8544
Country	:	US
Telephone Number	:	843-235-8098
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEN HALL
Credential	:
Telephone Number	:	763-268-4000

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	01/19/2022

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