1376624320 NPI number — RI-LEE MEDICAL STAFFING, INC.

Table of content: (NPI 1376624320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376624320 NPI number — RI-LEE MEDICAL STAFFING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RI-LEE MEDICAL STAFFING, 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:
FOGARTY SURGICAL SERVICES AND FAMILY CARE CLINIC
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:
1376624320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 144
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMERON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54822-0144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-458-3124
Provider Business Mailing Address Fax Number:
715-458-3125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
902 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMERON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54822-4910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-458-3124
Provider Business Practice Location Address Fax Number:
715-458-3125
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOGARTY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
715-455-3124

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 1845 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 1673 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 21288500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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