Mea-Aea Kenosha Sc

LBN: Mea-Aea Kenosha Sc
Mea-Aea Kenosha Sc is an health care organization with primary practice located at 10400 75Th St , Kenosha WI 53142-7884. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is the primary health care specialty. Mea-Aea Kenosha Sc can be contacted via phone (262) 948-5640, or through Holtzclaw, Stephen via phone (440) 887-4718.

Contact Information

Primary practice address
10400 75Th St Kenosha WI 53142-7884
Phone: (262) 948-5640
Fax: (440) 842-8835
Website:
Map and Directions
Authorized official contact:
Name: Holtzclaw, Stephen Doctor of Medicine (MD)
Phone: (440) 887-4718

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X

Profile Details

NPI number 1477546737
LBN Legal business name Mea-Aea Kenosha Sc
DBA Doing business as
Authorized official Holtzclaw, Stephen Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 23rd, 2005
Last updated Feb 21st, 2012 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477546737 NPPES
Wisconsin MEDICAID 21262900

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