Organization
METHODIST MANOR HEALTH CENTER, INC.
Active
Other names
Olsen Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES ENLUND (PRESIDENT & CEO)
(414) 607-4100
Entity
Organization
Contact information
Practice address
8520 W OKLAHOMA AVE, WEST ALLIS, WI 53227-4604
(414) 607-4291
(414) 607-4530
Mailing address
3023 S 84TH ST, WEST ALLIS, WI 53227-3703
(414) 607-4100
(414) 607-4502
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
WI
261Q00000X
Clinic/Center
—
WI
261QH0100X
Health Service Clinic/Center
Primary
—
WI
261QH0700X
Hearing and Speech Clinic/Center
—
WI
261QM0850X
Adult Mental Health Clinic/Center
—
WI
261QM2500X
Medical Specialty Clinic/Center
—
WI
261QP2000X
Physical Therapy Clinic/Center
—
WI
261QP2300X
Primary Care Clinic/Center
—
WI
261QR0400X
Rehabilitation Clinic/Center
—
WI
261QX0100X
Occupational Medicine Clinic/Center
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32865700
—
WI
Enumeration date
03/01/2006
Last updated
04/08/2009
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