MEDICARE: MOTHERS 4 PRENATAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1306502919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTHERS 4 PRENATAL LLC

Provider Business Mailing Address
First Line	:	3213 N 3RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2023
Country	:	US
Telephone Number	:	414-299-8799
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 N 3RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-2023
Country	:	US
Telephone Number	:	414-299-8799
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA MATHIS
Credential	:
Telephone Number	:	414-299-8799

Provider Enumeration Date	:	11/09/2021
Last Update Date	:	11/13/2021

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