Active NPI
Methodist Manor Health Center, Inc.
- Pharmacy
- West Allis, WI
National Provider Identifier
1073580403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 6309
- Legal business name
- METHODIST MANOR HEALTH CENTER, INC.
- Practice address
- 8615 W Beloit Rd
West Allis, WI 53227-3711 - Phone
- (414) 607-2165
- Fax
- (414) 607-4507
- NPI assigned
- Mar 3, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. James Enlund
- Title
- President & Ceo
- Phone
- (414) 607-4100
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 6309 | WI | Primary |
Addresses
Primary practice location
8615 W Beloit Rd
West Allis, WI 53227-3711
Mailing address
3023 S 84TH St
West Allis, WI 53227-3703
Phone (414) 607-4100
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5116187 | Other | WI | NCPDP NUMBER |
| 6309 | Other | WI | STATE LICENSE NUMBER |
| 33028500 | Medicaid | WI |
Other names 1
- Manor Pharmacy
National Provider Directory
National Provider Directory- Tax ID family
- Manor Pharmacy
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Skilled Nursing Facility
- West Allis, WI
- NPI 1134196983
-
- Health Service Clinic/Center
- Milwaukee, WI
- NPI 1235106576
-
- Pharmacy
- Milwaukee, WI
- NPI 1518934264
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141344000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1678147200000",
"number": "1073580403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3023 S 84TH ST",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "532273703",
"telephone_number": "414-607-4100",
"fax_number": "414-607-4502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8615 W BELOIT RD",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "532273711",
"telephone_number": "414-607-2165",
"fax_number": "414-607-4507"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "METHODIST MANOR HEALTH CENTER, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-03-03",
"last_updated": "2023-03-07",
"status": "A",
"authorized_official_last_name": "ENLUND",
"authorized_official_first_name": "JAMES",
"authorized_official_title_or_position": "PRESIDENT & CEO",
"authorized_official_telephone_number": "414-607-4100",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "WI",
"license": "6309",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP NUMBER",
"identifier": "5116187",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "6309",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33028500",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Manor Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in West Allis, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.