Basic Information
| Provider Information | |||||||||
| NPI: | 1811095003 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WESTHILL HOME MEDICAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 920 N WESTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | APPLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549145790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207493777 | ||||||||
| FaxNumber: | 9207493763 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 N WESTHILL BLVD | ||||||||
| Address2: | |||||||||
| City: | APPLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549145790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207493777 | ||||||||
| FaxNumber: | 9207493763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MALKOWSKI | ||||||||
| AuthorizedOfficialFirstName: | THEODORE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9207493777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | 41755800 | 05 | WI | MEDICAID |