1255334173 NPI number — FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC.

Table of content: (NPI 1255334173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255334173 NPI number — FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FROEDTERT MEMORIAL LUTHERAN HOSPITAL, 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:
FROEDTERT HOSPITAL
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:
1255334173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N74 W12501 LEATHERWOOD CT
Provider Second Line Business Mailing Address:
WOODLAND PRIME 400, PFS, ATTN: T. LEMMERMANN
Provider Business Mailing Address City Name:
MENOMONEE FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53051-4490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-777-0417
Provider Business Mailing Address Fax Number:
414-777-0096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9200 W WISCONSIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-805-3000
Provider Business Practice Location Address Fax Number:
414-805-7790
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CONLEY
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
414-805-2915

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 232; 279 , 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: 501166 . This is a "DEAN HEALTH PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 0939538 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121634105 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11000400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 923550700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137793700 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 2277487 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 304656043 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5000021 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: E61000134 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 404656061 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 88601544 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100036370A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 092365600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000355 . This is a "TOUCHPOINT" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 0095078 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01869896 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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