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General NPI Number Information
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NPI Number | 1508027905
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Entity Type | Organization
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Legal Business Name | WISCONSIN COMMUNITY SERVICES, INC.
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 06/11/2014
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Provider Practice Location Address
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Address Line | 230 W. WELLS ST. SUITE 500
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City | MILWAUKEE
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State | WI
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Zip | 53203-1845
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Country | US
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Telephone | 414-290-0440
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Fax | 414-226-0351
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Provider Business Mailing Address
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Address Line | 3732 W. WISCONSIN AVENUE
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City | MILWAUKEE
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State | WI
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Zip | 53208-3166
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Country | US
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Telephone | 414-290-0400
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Fax | 414-271-4605
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. HOLLIS ANN PATZER
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Credential |
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Telephone | 414-290-0400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 52D0914885
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License Number State | WI
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