1336280403 NPI number — DELTA MEDICAL EQUIPMENT,LLC

Table of content: JOHN MICHAEL JANSEN MD (NPI 1437711520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336280403 NPI number — DELTA MEDICAL EQUIPMENT,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELTA MEDICAL EQUIPMENT,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336280403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5678 W BROWN DEER RD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53223-2365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-586-0553
Provider Business Mailing Address Fax Number:
414-586-0551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5678 W BROWN DEER RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53223-2365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-586-0553
Provider Business Practice Location Address Fax Number:
414-586-0551
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
CHARMAINE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
414-586-0553

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  004000231718601 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 41748500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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