Healthcare Provider Details

I. General information

NPI: 1194127514
Provider Name (Legal Business Name): NEW AGE BILLING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 N 47TH STREET
MILWAUKEE WI
53210
US

IV. Provider business mailing address

2802 N 47TH STREET
MILWAUKEE WI
53210
US

V. Phone/Fax

Practice location:
  • Phone: 414-595-6592
  • Fax: 414-312-7874
Mailing address:
  • Phone: 414-595-6592
  • Fax: 414-312-7874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BARBARA WALKER
Title or Position: BILLER
Credential:
Phone: 414-595-6592