MEDICARE: QUALITY ADDICTION MANAGEMENT

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	261QM2800X	Methadone Clinic	2236	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659522613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY ADDICTION MANAGEMENT

Provider Business Mailing Address
First Line	:	1610 MILLER PARK WAY
Second Line	:
City	:	WEST MILWAUKEE
State	:	WI
Zip	:	53214-3604
Country	:	US
Telephone Number	:	414-672-3801
Fax Number	:	414-672-6026

Provider Business Practice Location Address
First Line	:	1610 MILLER PARK WAY
Second Line	:
City	:	WEST MILWAUKEE
State	:	WI
Zip	:	53214-3604
Country	:	US
Telephone Number	:	414-672-3801
Fax Number	:	414-672-6026

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ELIZABETH ANN GILBERT
Credential	:	RN
Telephone Number	:	262-549-6600

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/08/2008

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Directions to “QUALITY ADDICTION MANAGEMENT ” Practice Location

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