NPI 1841694650

Vintage View Farm INC

Organisation Preferred Provider Organization Mequon, WI

Practice location

Address: 7230 W Highland Rd, Mequon, WI 53092-1002
Phone: (262) 242-1110
Fax: (262) 236-9589

Authorised official

Name: Adam Wallow
Title: Managing Principal
Phone: (262) 242-1110

Registered specialties (2)

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

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Specialist

Other Service Providers Taxonomy 174400000X

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Registry record

NPI: 1841694650
Entity type: Organization
NPI issued: 22 Oct 2014
Record last updated: 7 Dec 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.