1134671308 NPI number — NSH SOUTH SHORE LLC

Table of content: (NPI 1134671308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134671308 NPI number — NSH SOUTH SHORE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NSH SOUTH SHORE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. FRANCIS HEALTH SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134671308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5150 N PORT WASHINGTON RD
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53217-5474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-962-5250
Provider Business Mailing Address Fax Number:
414-962-5251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1915 E TRIPOLI AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST FRANCIS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53235-4142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-962-5250
Provider Business Practice Location Address Fax Number:
414-962-5251
Provider Enumeration Date:
11/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HOEHN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
414-962-5250

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2922 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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