MEDICARE: AMEDISYS WISCONSIN 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	251E00000X	Home Health Agency	1170	WI

General Provider Information

NPI Number	:	1467602847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMEDISYS WISCONSIN LLC

Provider Business Mailing Address
First Line	:	3854 AMERICAN WAY
Second Line	:	SUITE A
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-4013
Country	:	US
Telephone Number	:	225-292-2031
Fax Number	:	225-295-9678

Provider Business Practice Location Address
First Line	:	2120 S RIDGE RD
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-4327
Country	:	US
Telephone Number	:	920-497-1234
Fax Number	:	920-497-1236

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL KUSSEROW
Credential	:
Telephone Number	:	225-292-2031

Provider Enumeration Date	:	09/23/2008
Last Update Date	:	01/18/2017

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