Provider Demographics
NPI:1639148398
Name:METRO CARE HOME MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:METRO CARE HOME MEDICAL CENTER, INC.
Other - Org Name:METROCARE HOME MEDICAL EQUIPMENT, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:POTEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-250-0820
Mailing Address - Street 1:9225 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1058
Mailing Address - Country:US
Mailing Address - Phone:262-250-0820
Mailing Address - Fax:262-250-0825
Practice Address - Street 1:9225 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-1058
Practice Address - Country:US
Practice Address - Phone:262-250-0820
Practice Address - Fax:262-250-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI004000019571401332BC3200X
WI0040000019571401332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41682400Medicaid
WI41682400Medicaid