| Pain Management & Healthcare Of West Allis, Llc | |
|
6751 W Greenfield Ave West Allis WI 53214-4966 | |
| (414) 777-5066 | |
| (414) 777-5067 |
| Full Name | Pain Management & Healthcare Of West Allis, Llc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 6751 W Greenfield Ave, West Allis, Wisconsin |
| Authorized Official Name and Position | Barbara J Johnson Farmer (OWNER, CEO) |
| Authorized Official Contact | 4147775066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pain Management & Healthcare Of West Allis, Llc 6751 W Greenfield Ave West Allis WI 53214-4966 Ph: (414) 777-5066 | Pain Management & Healthcare Of West Allis, Llc 6751 W Greenfield Ave West Allis WI 53214-4966 Ph: (414) 777-5066 |
| NPI Number | 1538597521 |
|---|---|
| Provider Enumeration Date | 10/29/2013 |
| Last Update Date | 08/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538597521 | NPI | - | NPPES |
| 1306947817 | Medicaid | WI | |
| 100040897 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 2798-33 (Wisconsin) | Primary |
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