Northwest Wisconsin Community Services Agency Inc.

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

NORTHWEST WISCONSIN COMMUNITY SERVICES AGENCY INC.

Practice address

1805 N 14TH St Ste 4
Superior, WI 54880-8802

Phone

(715) 394-2750

Fax

(715) 394-4651

NPI assigned

Aug 14, 2007

Last updated

Sep 20, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mary Elizabeth Mahan, RD, CLE

Title

Wic Program Director

Phone

(715) 394-2750

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316476800000",
    "number": "1053503946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 N 14TH ST STE 4",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548808802",
            "telephone_number": "715-394-2750",
            "fax_number": "715-394-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 N 14TH ST STE 4",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548808802",
            "telephone_number": "715-394-2750",
            "fax_number": "715-394-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST WISCONSIN COMMUNITY SERVICES AGENCY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-14",
        "last_updated": "2011-09-20",
        "status": "A",
        "authorized_official_last_name": "MAHAN",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "WIC PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "715-394-2750",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RD, CLE"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44012100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Case Management Agency in Superior, WI
• Providers in Superior, WI by specialty
• Case Management Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.