Provider Demographics
NPI:1134782964
Name:CHARTWELL MIDWEST WISCONSIN, LLC
Entity type:Organization
Organization Name:CHARTWELL MIDWEST WISCONSIN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-831-8555
Mailing Address - Street 1:1345 DEMING WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3688
Mailing Address - Country:US
Mailing Address - Phone:068-831-8555
Mailing Address - Fax:
Practice Address - Street 1:1345 DEMING WAY STE 102
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3688
Practice Address - Country:US
Practice Address - Phone:068-831-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies