Individual ProviderSamuel SpencerPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address10625 W North Ave, Suite 102, Milwaukee, WI 53226-2315(414) 877-5350PECOS EnrollmentBased on the most recent information from CMS, provider Samuel Spencer is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1396018875Provider TypeIndividualFull NameSpencer, SamuelCredentialPACGenderMaleSole ProprietorNoEnumeration Date2/15/2012Last Updated4/21/2017Contact InformationPractice LocationPractice Address10625 W North Ave, Suite 102, Milwaukee, WI 53226-2315Phone(414) 877-5350Fax(414) 877-5360Mailing LocationMailing Address10625 W North Ave, Suite 102, Milwaukee, WI 53226-2315Phone(414) 877-5350Fax(414) 877-5360Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense289123Wisconsin