MEDICARE: INDEPENDENCEFIRST

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	251E00000X	Home Health Agency
2	251E00000X	Home Health Agency	43104200	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336143395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENCEFIRST

Provider Business Mailing Address
First Line	:	540 S 1ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1605
Country	:	US
Telephone Number	:	414-291-7520
Fax Number	:	414-291-7525

Provider Business Practice Location Address
First Line	:	540 S 1ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1605
Country	:	US
Telephone Number	:	414-291-7520
Fax Number	:	414-291-7525

Authorized Official
Title or Position	:	COO
Name	:	MRS. DEB LANGHAM
Credential	:
Telephone Number	:	414-226-8371

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	04/24/2019

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Directions to “INDEPENDENCEFIRST ” Practice Location

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