MEDICARE: MISSION HEALTHCARE SERVICES 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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1164227401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	4821 N 64TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4020
Country	:	US
Telephone Number	:	262-599-4468
Fax Number	:

Provider Business Practice Location Address
First Line	:	4821 N 64TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4020
Country	:	US
Telephone Number	:	262-599-4468
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	REGINALD CEPHUS
Credential	:
Telephone Number	:	262-450-5045

Provider Enumeration Date	:	02/19/2025
Last Update Date	:	12/03/2025

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Directions to “MISSION HEALTHCARE SERVICES LLC ” Practice Location

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