Provider Demographics
NPI:1104015007
Name:USA MEDICAL SUPPLIERS, LTD.
Entity Type:Organization
Organization Name:USA MEDICAL SUPPLIERS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIHALOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:608-782-1855
Mailing Address - Street 1:1919 STATE RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5835
Mailing Address - Country:US
Mailing Address - Phone:608-782-1855
Mailing Address - Fax:608-782-1856
Practice Address - Street 1:1919 STATE RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-5835
Practice Address - Country:US
Practice Address - Phone:608-782-1855
Practice Address - Fax:608-782-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI332BC3200X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104015007Medicaid
IN1104015007Medicaid
MN1104015007Medicaid
IA1104015007Medicaid
IA1104015007Medicaid