Provider Demographics
NPI:1912605361
Name:WISCONSIN ACCESS NATIONAL, LLC
Entity Type:Organization
Organization Name:WISCONSIN ACCESS NATIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:CLEMENTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-768-0411
Mailing Address - Street 1:1411 LINDBERG DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8057
Mailing Address - Country:US
Mailing Address - Phone:985-707-2790
Mailing Address - Fax:985-707-2790
Practice Address - Street 1:910 ELM GROVE RD STE 16
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2531
Practice Address - Country:US
Practice Address - Phone:985-768-0411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCESS HOME CARE SOLUTIONS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-15
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion