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General NPI Number Information
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NPI Number | 1861615874
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Entity Type | Organization
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Legal Business Name | WISCONSIN COMMUNITY SERVICES, INC. DRUG EVALUATION LABORATORY
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 949 N 9TH ST ROOM 131E
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City | MILWAUKEE
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State | WI
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Zip | 53233-1422
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Country | US
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Telephone | 414-223-1329
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Fax | 414-223-1836
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Provider Business Mailing Address
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Address Line | 3732 W WISCONSIN AVE SUITE 200
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City | MILWAUKEE
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State | WI
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Zip | 53208-3153
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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 | HOLLIS PATZER
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Credential |
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Telephone | 414-290-0418
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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 | 2133-800
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License Number State | WI
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