1053360933 NPI number — INFINITY HEALTHCARE PHYSICIANS, S.C.

Table of content: (NPI 1053360933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053360933 NPI number — INFINITY HEALTHCARE PHYSICIANS, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INFINITY HEALTHCARE PHYSICIANS, S.C.
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:
Provider Other Organization Name Type Code:
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:
1053360933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 E WISCONSIN AVE
Provider Second Line Business Mailing Address:
SUITE 2000
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53202-4815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-290-6720
Provider Business Mailing Address Fax Number:
414-290-6718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13111 N PORT WASHINGTON RD
Provider Second Line Business Practice Location Address:
COLUMBIA ST. MARY'S - OZAUKEE CAMPUS
Provider Business Practice Location Address City Name:
MEQUON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53097-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-290-6718
Provider Business Practice Location Address Fax Number:
414-290-6755
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KONDAS
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
954-838-2371

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 32851400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 369450305 . This is a "OWCP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: CD4252 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 110008982 . This is a "WEA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com