Provider Demographics
NPI:1184901878
Name:WHOLE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:WHOLE HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
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:SUITE 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:SUITE 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:2011-11-08
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI177540-30163W00000X
WI84-049176B00000X
WI4484-033367A00000X
WI148850-032367A00000X
261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI52D1011155OtherCLIA
WI98256900Medicaid
WI38256900Medicaid