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Samuel Colt Farley

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

2600 N Mayfair Rd Ste 580, Milwaukee, WI 53226-1321

PECOS Enrollment

This provider is enrolled in PECOS as SAMUEL FARLEY.

Based on the most recent information from CMS, provider Samuel Colt Farley is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1942039318
Provider Type
Individual
Full Name
Farley, Samuel Colt
Gender
Male

Sole Proprietor
No
Enumeration Date
8/1/2024
Last Updated
5/14/2025

Contact Information

Practice Location

2600 N Mayfair Rd Ste 580, Milwaukee, WI 53226-1321

(414) 732-2715

(414) 476-3242

Mailing Location

2600 N Mayfair Rd Ste 580, Milwaukee, WI 53226-1321

(414) 476-0430

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 8181-23 Wisconsin

Provider Identifiers

ID	Description	Issuer
ID 8181-23	Description Other	Issuer STATE LICENSE Wisconsin

Samuel Colt Farley

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Andreae, Faustina

Krueger, Kathryn E

Strege, Brittni Marie

Reinhardt, Shelby Rae

Schellhaas, Erica A

Burns, Gabrielle

Flatley, Ann M

Gangl, Joshua

Gustavson, Kristin Margaret

Thakrar, Anjali D