Provider Demographics
NPI:1861682411
Name:MANAGED HEALTH SERVICES INSURANCE CORP.
Entity type:Organization
Organization Name:MANAGED HEALTH SERVICES INSURANCE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHOREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-720-5567
Mailing Address - Street 1:1205 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3167
Mailing Address - Country:US
Mailing Address - Phone:414-345-4620
Mailing Address - Fax:414-259-2153
Practice Address - Street 1:801 S 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-9800
Practice Address - Country:US
Practice Address - Phone:414-345-4620
Practice Address - Fax:414-259-2153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTENE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-30
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIHMO 69002400302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization