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Contact Information

MEDICAID
1125 GENEVA RD
MENASHA, WI54952-1505
 Phone: 920-450-8323
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Custodial Care Facility

311Z00000X
 

Nursing Care, Pediatric

3140N1450X
Indicates primary specialty

NPI Profile & details for MEDICAID

NPI # 1336109776
LBN Legal business name MEDICAID
Authorized official LORI FARRAGH - (RN)
Entity Organization
Organization subpart 1 No
Enumeration date 03/27/2006
Last updated 09/11/2025 - About 9 months ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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