Independent Living Supplies, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

INDEPENDENT LIVING SUPPLIES, LLC

Practice address

6100 W Bluemound Rd
Wauwatosa, WI 53213-4143

Phone

(414) 329-3962

Fax

(414) 329-3970

NPI assigned

Jul 22, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Roxanne L Peterson

Title

Member

Phone

(414) 329-3962

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199232000000",
    "number": "1649270356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 W BLUEMOUND RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532134143",
            "telephone_number": "414-329-3962",
            "fax_number": "414-329-3970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 W BLUEMOUND RD",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532134143",
            "telephone_number": "414-329-3962",
            "fax_number": "414-329-3970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT LIVING SUPPLIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2008-01-02",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "ROXANNE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "414-329-3962",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41733300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2008; 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.