Provider Demographics
NPI:1306030762
Name:LAYTON MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:LAYTON MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNATED DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BORISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:KRESOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:414-282-3634
Mailing Address - Street 1:5790 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-4129
Mailing Address - Country:US
Mailing Address - Phone:414-282-3634
Mailing Address - Fax:
Practice Address - Street 1:5790 S 27TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-4129
Practice Address - Country:US
Practice Address - Phone:414-282-3634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI004-0000158658-01332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0275090001Medicare NSC
0275090001Medicare PIN