1740511161 NPI number — CSM COMMUNITY PHYSICIANS

Table of content: (NPI 1740511161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740511161 NPI number — CSM COMMUNITY PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CSM COMMUNITY PHYSICIANS
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:
CSMCP CARDIAC RHYTHM SPECIALIST
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:
1740511161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 78309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53278-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-298-7280
Provider Business Mailing Address Fax Number:
414-298-7281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1414 N TAYLOR DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHEBOYGAN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53081-1988
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-298-7280
Provider Business Practice Location Address Fax Number:
414-298-7281
Provider Enumeration Date:
01/25/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BJORN
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
414-298-7284

Provider Taxonomy Codes

  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 32793800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com