Phoenix Medical Supplies LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

456-1028557037-02 Issued in WI

Legal business name

PHOENIX MEDICAL SUPPLIES LLC

Practice address

512 Oakland Ave
Waukesha, WI 53186-5573

Phone

(262) 955-8911

NPI assigned

Aug 13, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Jacob Nielsen

Title

Owner

Phone

(262) 955-8911

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1376352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376352000000",
    "number": "1770916892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 OAKLAND AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531865573",
            "telephone_number": "262-955-8911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 OAKLAND AVE",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531865573",
            "telephone_number": "262-955-8911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX MEDICAL SUPPLIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-13",
        "last_updated": "2013-08-13",
        "status": "A",
        "authorized_official_last_name": "NIELSEN",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-955-8911",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WI",
            "license": "456-1028557037-02",
            "primary": true
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "WI",
            "license": "456-1028557037-02",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "WI",
            "license": "456-1028557037-02",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelli K Pettit, MD
• Pewaukee Vision SC
• Camthu Minh Pham, O.D.
• Phillip L. Bangle, D.D.S. S.C.
• Danielle Phillips, RDH, DA
• Shauna Pichette, LPC, NCC
• Deborah Pichler, APNP, FNP-BC, PMHNP
• Carolyn Pieper
• Kara Pierce
• Dawn Pierson, MSN, APNP

• Durable Medical Equipment & Medical Supplies in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Durable Medical Equipment & Medical Supplies in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2013; 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.