Provider Demographics
NPI:1912181793
Name:METROCARE HOME MEDICAL - GREENFIELD
Entity type:Organization
Organization Name:METROCARE HOME MEDICAL - GREENFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:POTEET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-345-3081
Mailing Address - Street 1:6825 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3818
Mailing Address - Country:US
Mailing Address - Phone:262-345-3081
Mailing Address - Fax:262-250-0825
Practice Address - Street 1:W188N11927 MAPLE RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-6328
Practice Address - Country:US
Practice Address - Phone:262-345-3081
Practice Address - Fax:262-250-0825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0786520002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41740300Medicaid
WI41740300Medicaid