=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881313922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VELM PAYEE SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2022
-----------------------------------------------------
Last Update Date | 08/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1737 S 61ST ST
-----------------------------------------------------
City | WEST ALLIS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53214-5005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-229-9158
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1737 S 61ST ST
-----------------------------------------------------
City | WEST ALLIS
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53214-5005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-229-9158
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. GUADALUPE MACIAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-229-9158
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305R00000X
-----------------------------------------------------
Taxonomy Name | Preferred Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------