Basic Information
| Provider Information | |||||||||
| NPI: | 1053319285 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METZ MEDICAL INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 4720 GREEN BAY RD | ||||||||
| Address2: | |||||||||
| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531441719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626544000 | ||||||||
| FaxNumber: | 2626545400 | ||||||||
| Practice Location | |||||||||
| Address1: | 4720 GREEN BAY RD | ||||||||
| Address2: | |||||||||
| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531441719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626544000 | ||||||||
| FaxNumber: | 2626545400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MARX | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4402323000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | 2097-028 | WI | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 1297-045 | 01 | WI | DEPT REG/LIC - DISTRIBUTO | OTHER | 315-044 | 01 | WI | DEPT OF REG/LIC - MANUFAC | OTHER | 040018300 | 01 | FEDERAL BLACK PROGRAM | OTHER | 8009-042 | 01 | WI | DEPT REG/LIC- PHARMACY | OTHER | 203.001469 | 01 | IL | DEPT OF FINAN & PROF REG - HME & SERVICES PROVIDER | OTHER | 2097-028 | 01 | WI | DEPT REG/LIC- RESP CARE P | OTHER | 41694800 | 05 | WI | MEDICAID | 2556-45 | 01 | WI | DEPT REG/LIC - DISTRIBUTOR OF PRESC DRUGS | OTHER | 9408-40 | 01 | WI | DSPS - PHARMACY EXAMINING BOARD | OTHER |