Provider Demographics
NPI:1053563031
Name:PENFIELD CHILDREN'S CENTER DME
Entity type:Organization
Organization Name:PENFIELD CHILDREN'S CENTER DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/V.P. ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CIARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-345-6303
Mailing Address - Street 1:833 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1507
Mailing Address - Country:US
Mailing Address - Phone:414-344-7676
Mailing Address - Fax:414-344-7399
Practice Address - Street 1:833 N 26TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1507
Practice Address - Country:US
Practice Address - Phone:414-344-7676
Practice Address - Fax:414-344-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41618000Medicaid