1346353695 NPI number — WAUKESHA HEALTH SYSTEM, INC.

Table of content: (NPI 1346353695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346353695 NPI number — WAUKESHA HEALTH SYSTEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAUKESHA HEALTH SYSTEM, INC.
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:
BEHAVIORAL MEDICINE CENTER
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:
1346353695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 AMERICAN AVE
Provider Second Line Business Mailing Address:
SUITE 501
Provider Business Mailing Address City Name:
WAUKESHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53188-5071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-928-2396
Provider Business Mailing Address Fax Number:
262-544-1213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 AMERICAN AVE
Provider Second Line Business Practice Location Address:
SUITE 501
Provider Business Practice Location Address City Name:
WAUKESHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53188-5071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-928-2396
Provider Business Practice Location Address Fax Number:
262-544-1213
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SYRJANEN
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
252-928-2382

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  1976 , 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)

  • Identifier: 42125500 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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