Provider Demographics
NPI:1992846836
Name:SPECIALIZED MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:SPECIALIZED MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:727-530-7700
Mailing Address - Street 1:5343 N 118TH CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3085
Mailing Address - Country:US
Mailing Address - Phone:414-476-1112
Mailing Address - Fax:414-476-6118
Practice Address - Street 1:2875 S 171ST ST
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-3511
Practice Address - Country:US
Practice Address - Phone:414-476-1112
Practice Address - Fax:414-476-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND51264Medicaid
AZ906662Medicaid
IN200479890Medicaid
WY120638900Medicaid
CO93022557Medicaid
NV100505103Medicaid
MI4568192Medicaid
WI41709300Medicaid
ID807398300Medicaid
WA9056573Medicaid
TX1715138Medicaid
OH2478457Medicaid
SCDM1182Medicaid
WI41709300Medicaid
AZ906662Medicaid
WA0702730002Medicare NSC