Provider Demographics
NPI:1174931836
Name:DIRECT MEDICAL ACCESS SERVICES
Entity type:Organization
Organization Name:DIRECT MEDICAL ACCESS SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KLIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-903-4455
Mailing Address - Street 1:638 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1908
Mailing Address - Country:US
Mailing Address - Phone:262-215-9085
Mailing Address - Fax:262-248-3801
Practice Address - Street 1:638 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1908
Practice Address - Country:US
Practice Address - Phone:262-215-9085
Practice Address - Fax:262-248-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI100032541253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100032541Medicaid