Provider Demographics
NPI:1679761225
Name:FREEDOM MEDICAL,LLC
Entity type:Organization
Organization Name:FREEDOM MEDICAL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/ATP
Authorized Official - Phone:715-830-6900
Mailing Address - Street 1:2236 HEIMSTEAD RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-4953
Mailing Address - Country:US
Mailing Address - Phone:715-830-9600
Mailing Address - Fax:715-833-8079
Practice Address - Street 1:2236 HEIMSTEAD RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-4953
Practice Address - Country:US
Practice Address - Phone:715-830-9600
Practice Address - Fax:715-833-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1679761225Medicaid
WI6311940001Medicare NSC