Healthcare Provider Details

I. General information

NPI: 1669554911
Provider Name (Legal Business Name): METROCARE HOME MEDICAL EQUIPMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 N 76TH ST
MILWAUKEE WI
53223-1058
US

IV. Provider business mailing address

W188N11927 MAPLE RD
GERMANTOWN WI
53022-6328
US

V. Phone/Fax

Practice location:
  • Phone: 262-250-0820
  • Fax: 262-250-0825
Mailing address:
  • Phone: 262-250-0820
  • Fax: 262-250-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateWI

VIII. Authorized Official

Name: MR. JIM LEWIS POTEET
Title or Position: PRESIDENT
Credential:
Phone: 262-250-0820