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NPI Code Detail

MEDICARE: HAILEY EHR

MEDICARE: HAILEY EHR
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
1363AM0700XMedical Physician Assistant

General Provider Information

NPI Number : 1063367258
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAILEY EHR
Provider Business Mailing Address
First Line : 411 COVENTRY DR
Second Line :
City : PLOVER
State : WI
Zip : 54467-2109
Country : US
Telephone Number : 715-321-2813
Fax Number :
Provider Business Practice Location Address
First Line : 600 HIGHLAND AVE
Second Line :
City : MADISON
State : WI
Zip : 53792-0001
Country : US
Telephone Number : 603-263-6400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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Directions to “ HAILEY EHR ” Practice Location

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