MEDICARE: MILLWAY HEALTHCARE 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	314000000X	Skilled Nursing Facility	3231	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5048560001	OTHER	WI	DME
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306843875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLWAY HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	8534 W MILL RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-1934
Country	:	US
Telephone Number	:	414-353-2300
Fax Number	:	414-353-2727

Provider Business Practice Location Address
First Line	:	8534 W MILL RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53225-1934
Country	:	US
Telephone Number	:	414-353-2300
Fax Number	:	414-353-2727

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	MRS. CHRISTINA CAROL ROOP
Credential	:
Telephone Number	:	863-324-4739

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	01/31/2008

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