Provider Demographics
NPI:1174734883
Name:MSS WELLNESS PROGRAMS LLC
Entity type:Organization
Organization Name:MSS WELLNESS PROGRAMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WALTHER
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-748-3197
Mailing Address - Street 1:612 E PERKINS ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1913
Mailing Address - Country:US
Mailing Address - Phone:715-748-3197
Mailing Address - Fax:715-748-0559
Practice Address - Street 1:N1882 W SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:OGEMA
Practice Address - State:WI
Practice Address - Zip Code:54459-8304
Practice Address - Country:US
Practice Address - Phone:715-767-5360
Practice Address - Fax:715-767-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1813-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty