MEDICARE: WISCONSIN MEDICAL SUPPLIES INC

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	332B00000X	Durable Medical Equipment & Medical Supplies

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	:	1982621827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISCONSIN MEDICAL SUPPLIES INC

Provider Business Mailing Address
First Line	:	5200 WASHINGTON AVE
Second Line	:	STE 105
City	:	RACINE
State	:	WI
Zip	:	53406-4238
Country	:	US
Telephone Number	:	262-631-0100
Fax Number	:	262-631-0200

Provider Business Practice Location Address
First Line	:	5200 WASHINGTON AVE
Second Line	:	STE 105
City	:	RACINE
State	:	WI
Zip	:	53406-4238
Country	:	US
Telephone Number	:	262-631-0100
Fax Number	:	262-631-0200

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YASER J MOHAMMED
Credential	:
Telephone Number	:	262-631-0100

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	03/27/2008

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