Healthcare Provider's Profile
Full Name | |
---|
Type | Facility |
---|
Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
---|
Location | 309 E North St, Waukesha, Wisconsin |
---|
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
NPI Data:
- NPI Number: 1083679385
- Provider Enumeration Date: 04/19/2006
- Last Update Date: 01/08/2025
Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1083679385 | NPI | - | NPPES |
32958300 | Medicaid | WI | |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
225100000X | Physical Therapist | (* (Not Available)) | Secondary |
225X00000X | Occupational Therapist | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
2906 S 20th St, Milwaukee, WI 53215-3732 Ph: (414) 672-1353 | 309 E North St, Waukesha, WI 53188-3718 Ph: (414) 672-1353 |
Reviews and Comments