Mid America Healthcare Corp of Wisconsin

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

527256 Issued in WI

Legal business name

MID AMERICA HEALTHCARE CORP OF WISCONSIN

Practice address

811 N Hawley Rd
Ste 201
Milwaukee, WI 53213-3289

Phone

(414) 578-2961

Fax

(414) 578-2962

NPI assigned

Aug 25, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Souphalack Khammyvong

Title

Administrator/ Don

Phone

(414) 578-2961

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328832000000",
    "number": "1477660132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 N HAWLEY RD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532133289",
            "telephone_number": "414-578-2961",
            "fax_number": "414-578-2962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 N HAWLEY RD",
            "address_2": "STE 201",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532133289",
            "telephone_number": "414-578-2961",
            "fax_number": "414-578-2962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID AMERICA HEALTHCARE CORP OF WISCONSIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2012-02-10",
        "status": "A",
        "authorized_official_last_name": "KHAMMYVONG",
        "authorized_official_first_name": "SOUPHALACK",
        "authorized_official_title_or_position": "ADMINISTRATOR/ DON",
        "authorized_official_telephone_number": "414-578-2961",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "WI",
            "license": "527256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43107100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Mickelson, M.D.
• Mandy Mickelson
• Grant James Mickesh, DDS
• Savannah Mickesh, APN
• Dara J Mickschl, PA-C
• Mid-South Home Care Services, LLC
• Middle Coast Therapy LLC
• Matthew James Midtling, D.D.S.
• Midtown Pharmacy SC
• Midwest Adult Home Care LLC

• Home Health Agency in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Home Health Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.