Provider Demographics
NPI:1861682411
Name:MANAGED HEALTH INSURANCE CORPORATION
Entity Type:Organization
Organization Name:MANAGED HEALTH INSURANCE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER UTILIZATION MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRYFKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:414-345-4620
Mailing Address - Street 1:1205 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3167
Mailing Address - Country:US
Mailing Address - Phone:414-345-4620
Mailing Address - Fax:414-259-2153
Practice Address - Street 1:1205 S 70TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3167
Practice Address - Country:US
Practice Address - Phone:414-345-4620
Practice Address - Fax:414-259-2153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTENE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIHMO 69002400302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization