Provider Demographics
NPI:1548374101
Name:NATIONAL PEDORTHIC SERVICES, INC.
Entity type:Organization
Organization Name:NATIONAL PEDORTHIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:JANISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-438-1216
Mailing Address - Street 1:7283 W APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1932
Mailing Address - Country:US
Mailing Address - Phone:414-438-1211
Mailing Address - Fax:414-438-1051
Practice Address - Street 1:885 WESTERN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3874
Practice Address - Country:US
Practice Address - Phone:920-907-1060
Practice Address - Fax:920-907-1064
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL PEDORTHIC SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-19
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41792700Medicaid
WI41792700Medicaid