Provider Demographics
NPI:1770724940
Name:AEGIS THERAPIES
Entity type:Organization
Organization Name:AEGIS THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WI MEDICAID BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-201-2844
Mailing Address - Street 1:428 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-1425
Mailing Address - Country:US
Mailing Address - Phone:715-453-2511
Mailing Address - Fax:
Practice Address - Street 1:428 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TOMAHAWK
Practice Address - State:WI
Practice Address - Zip Code:54487-1425
Practice Address - Country:US
Practice Address - Phone:715-453-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11132-024314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility