Basic Information
| Provider Information | |||||||||
| NPI: | 1447424270 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11040 N STATE ROAD 77 | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548436391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7159344321 | ||||||||
| FaxNumber: | 7159344379 | ||||||||
| Practice Location | |||||||||
| Address1: | 11040 N STATE ROAD 77 | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548436391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7159344321 | ||||||||
| FaxNumber: | 7159344379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2008 | ||||||||
| LastUpdateDate: | 04/23/2018 | ||||||||
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| AuthorizedOfficialLastName: | BEIRL | ||||||||
| AuthorizedOfficialFirstName: | LUKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7159344244 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MEDICAL SERVICES, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 1040 | WI | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | 32945600 | 05 | WI | MEDICAID |