Provider Demographics
NPI:1851319594
Name:CARTERS MEDICAL EQUIPMENT AND SUPPLIES INC
Entity Type:Organization
Organization Name:CARTERS MEDICAL EQUIPMENT AND SUPPLIES INC
Other - Org Name:CARTERS MEDICAL AND EDUCATIONAL SERVICE INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-438-0522
Mailing Address - Street 1:4345 N 60 ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1209
Mailing Address - Country:US
Mailing Address - Phone:414-438-0522
Mailing Address - Fax:414-438-0380
Practice Address - Street 1:4345 N 60 ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1209
Practice Address - Country:US
Practice Address - Phone:414-438-0522
Practice Address - Fax:414-438-0380
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO HOME HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI004000011500701332000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41658500Medicaid
=========OtherFED TAXID FOR FAMILY CARE
WI0199960001Medicare ID - Type Unspecified