Provider Demographics
NPI:1205816857
Name:NATIONAL PEDORTHIC SERVICES, INC.
Entity Type:Organization
Organization Name:NATIONAL PEDORTHIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JANISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-438-1216
Mailing Address - Street 1:7283 W APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1932
Mailing Address - Country:US
Mailing Address - Phone:414-438-1216
Mailing Address - Fax:414-438-1051
Practice Address - Street 1:2475 N 124TH ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4630
Practice Address - Country:US
Practice Address - Phone:262-754-2440
Practice Address - Fax:262-754-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41770000Medicaid
WI0461190001Medicare NSC