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Organization

PHOENIX MEDICAL SUPPLIES LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JACOB NIELSEN (OWNER)
(262) 955-8911
Entity
Organization

Contact information

Practice address
512 OAKLAND AVE, WAUKESHA, WI 53186-5573
(262) 955-8911
Mailing address
512 OAKLAND AVE, WAUKESHA, WI 53186-5573
(262) 955-8911

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
456-1028557037-02
WI
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
456-1028557037-02
WI
332BX2000X
Oxygen Equipment & Supplies (DME)
456-1028557037-02
WI

Other

Enumeration date
08/13/2013
Last updated
08/13/2013
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