Basic Information
| Provider Information | |||||||||
| NPI: | 1740522945 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METZ MEDICAL, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | METZ MEDICAL, INC. | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1801 S GREEN BAY RD | ||||||||
| Address2: | |||||||||
| City: | RACINE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 534064605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626644000 | ||||||||
| FaxNumber: | 2626545400 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 S GREEN BAY RD | ||||||||
| Address2: | |||||||||
| City: | RACINE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 534064605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626644000 | ||||||||
| FaxNumber: | 2626545400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2013 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MARX | ||||||||
| AuthorizedOfficialFirstName: | JOSH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4402320000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | METZ MEDICAL, INC. | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BX2000X | 2097-28 | WI | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 040018300 | 01 | FEDERAL BLACK LUNG PROGRAM | OTHER | 9408-40 | 01 | WI | DEPT REG & LIC - PHARMACIST | OTHER | 41694800 | 05 | WI | MEDICAID | 1297-45 | 01 | WI | DEPT REG & LIC - DISTRIBUTOR | OTHER | 315-44 | 01 | WI | DEPT REG & LIC - MANUFACTURER | OTHER | 2097-28 | 01 | WI | DEPT REG & LIC - RESPIRATORY CARE PRACTITIONER | OTHER | 8009-42 | 01 | WI | DEPT REG & LIC - PHARMACY | OTHER |