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General NPI Number Information
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NPI Number | 1174931836
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Entity Type | Organization
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Legal Business Name | DIRECT MEDICAL ACCESS SERVICES
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Dates
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Enumeration Date | 07/25/2014
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 638 W MAIN ST SUITE A
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City | LAKE GENEVA
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State | WI
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Zip | 53147-1908
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Country | US
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Telephone | 262-215-9085
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Fax | 262-248-3801
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Provider Business Mailing Address
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Address Line | 638 W MAIN ST SUITE A
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City | LAKE GENEVA
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State | WI
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Zip | 53147-1908
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Country | US
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Telephone | 262-215-9085
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Fax | 262-248-3801
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Authorized Official
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Title or Position | OWNER ADMINISTRATOR
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Name | MRS. KAREN ANN KLIPP
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Credential |
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Telephone | 262-903-4455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 100032541
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License Number State | WI
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