Provider Demographics
NPI:1669640843
Name:ADVANCE CABLE COMPANY LLC
Entity Type:Organization
Organization Name:ADVANCE CABLE COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-831-1688
Mailing Address - Street 1:PO BOX 620033
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-0033
Mailing Address - Country:US
Mailing Address - Phone:608-831-1688
Mailing Address - Fax:608-831-9801
Practice Address - Street 1:2113 EAGLE DR
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-2551
Practice Address - Country:US
Practice Address - Phone:608-831-1688
Practice Address - Fax:608-831-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41568300Medicaid