Provider Demographics
NPI:1144324195
Name:MIKE FLINT ENTERPRISES INC
Entity type:Organization
Organization Name:MIKE FLINT ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FLINT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:608-310-9922
Mailing Address - Street 1:801 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:WI
Mailing Address - Zip Code:53555-1279
Mailing Address - Country:US
Mailing Address - Phone:608-592-3256
Mailing Address - Fax:608-592-7406
Practice Address - Street 1:801 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:WI
Practice Address - Zip Code:53555-1279
Practice Address - Country:US
Practice Address - Phone:608-592-3256
Practice Address - Fax:608-592-7406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 333600000X
WI9156-423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1144324195Medicaid
2137294OtherPK
0648470003Medicare NSC