Provider Demographics
NPI:1760755094
Name:WHOLE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:WHOLE HEALTH SERVICES LLC
Other - Org Name:MADISON BIRTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIESEKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-821-0123
Mailing Address - Street 1:6720 FRANK LLOYD WRIGHT AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-1753
Mailing Address - Country:US
Mailing Address - Phone:608-821-0123
Mailing Address - Fax:608-821-0124
Practice Address - Street 1:6720 FRANK LLOYD WRIGHT AVE
Practice Address - Street 2:STE 103
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-1753
Practice Address - Country:US
Practice Address - Phone:608-821-0123
Practice Address - Fax:608-821-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100003103Medicaid