Provider Demographics
NPI:1659357572
Name:MEDICAL CARE SPECIALISTS, INC.
Entity Type:Organization
Organization Name:MEDICAL CARE SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-784-9221
Mailing Address - Street 1:2665 S MOORLAND RD
Mailing Address - Street 2:#208
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-2900
Mailing Address - Country:US
Mailing Address - Phone:262-784-9221
Mailing Address - Fax:262-784-9227
Practice Address - Street 1:2665 S MOORLAND RD
Practice Address - Street 2:#208
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-2900
Practice Address - Country:US
Practice Address - Phone:262-784-9221
Practice Address - Fax:262-784-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21278800Medicaid
WI92040Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WI92035Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER