NPIMap

Organization Active NPI

Med Group Home Health Care Agency

  • Home Health Agency
  • Mequon, WI
National Provider Identifier
1609147958
Registry record updated Sep 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
MED GROUP HOME HEALTH CARE AGENCY
Practice address
11402 N Port Washington Rd
Suite 214 B
Mequon, WI 53092-3447
Phone
(414) 755-2009
Fax
(414) 755-1767
NPI assigned
Jan 18, 2012
Last updated
Sep 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2014

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

Authorized official

Name
Dariko Mekvabishvili
Title
President
Phone
(414) 745-3146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

11402 N Port Washington Rd
Suite 214 B
Mequon, WI 53092-3447

Mailing address

2111 N Dr Martin Luther King Dr
Milwaukee, WI 53212-3101
Phone (414) 755-2103

National Provider Directory

National Provider Directory

Locations

11402 N Port Washington Rd
Ste 214
Mequon, WI 53092
Phone (414) 755-2009

2111 N Dr Martin Luther King Dr
Milwaukee, WI 53212

NPI Registry JSON

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

{
    "created_epoch": "1326844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411603200000",
    "number": "1609147958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 N DR MARTIN LUTHER KING DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532123101",
            "telephone_number": "414-755-2103",
            "fax_number": "414-755-1784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11402 N PORT WASHINGTON RD",
            "address_2": "SUITE 214 B",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530923447",
            "telephone_number": "414-755-2009",
            "fax_number": "414-755-1767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED GROUP HOME HEALTH CARE AGENCY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-18",
        "last_updated": "2014-09-25",
        "status": "A",
        "authorized_official_last_name": "MEKVABISHVILI",
        "authorized_official_first_name": "DARIKO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-745-3146"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2014; 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.