Provider Demographics
NPI:1134276868
Name:MEDPARTNERS, INC
Entity type:Organization
Organization Name:MEDPARTNERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-476-2001
Mailing Address - Street 1:11830 W RIPLEY AVE
Mailing Address - Street 2:UNIT G
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3933
Mailing Address - Country:US
Mailing Address - Phone:414-476-2001
Mailing Address - Fax:414-476-2001
Practice Address - Street 1:11830 W RIPLEY AVE
Practice Address - Street 2:UNIT G
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3933
Practice Address - Country:US
Practice Address - Phone:414-476-2001
Practice Address - Fax:414-476-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41721900Medicaid
WI41721900Medicaid