Provider Demographics
NPI:1235368770
Name:WEST ALLIS ANIMAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:WEST ALLIS ANIMAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DVM
Authorized Official - Phone:414-476-3544
Mailing Address - Street 1:1736 S 82ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4425
Mailing Address - Country:US
Mailing Address - Phone:414-476-3544
Mailing Address - Fax:414-476-3529
Practice Address - Street 1:1736 S 82ND ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4425
Practice Address - Country:US
Practice Address - Phone:414-476-3544
Practice Address - Fax:414-476-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1974284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital