Provider Demographics
NPI:1174821847
Name:HEALTH SUPPORT SERVICES
Entity Type:Organization
Organization Name:HEALTH SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PIAS
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:414-899-1113
Mailing Address - Street 1:W243S8220 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:BIG BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53103-9610
Mailing Address - Country:US
Mailing Address - Phone:262-662-9774
Mailing Address - Fax:262-662-4752
Practice Address - Street 1:15350 W NATIONAL AVE STE 109
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-5158
Practice Address - Country:US
Practice Address - Phone:262-662-9774
Practice Address - Fax:262-662-4752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4768370001Medicare NSC