Provider Demographics
NPI:1881733152
Name:FORT MEDICAL EQUIPMENT LLC
Entity type:Organization
Organization Name:FORT MEDICAL EQUIPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-310-4730
Mailing Address - Street 1:306 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1741
Mailing Address - Country:US
Mailing Address - Phone:920-568-9860
Mailing Address - Fax:920-568-9861
Practice Address - Street 1:306 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1741
Practice Address - Country:US
Practice Address - Phone:920-568-9860
Practice Address - Fax:920-568-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41725100Medicaid
WI4328320001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER