1285685776 NPI number — WASHINGTON COUNTY WISCONSIN

Table of content: (NPI 1043502370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285685776 NPI number — WASHINGTON COUNTY WISCONSIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON COUNTY WISCONSIN
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:
WASHINGTON COUNTY HEALTH
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:
1285685776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 E WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 1100
Provider Business Mailing Address City Name:
WEST BEND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53095-2585
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-335-4462
Provider Business Mailing Address Fax Number:
262-335-4463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 1100
Provider Business Practice Location Address City Name:
WEST BEND
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53095-2585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-335-4462
Provider Business Practice Location Address Fax Number:
262-335-4463
Provider Enumeration Date:
05/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALTER
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR/HEALTH OFFICER
Authorized Official Telephone Number:
262-335-4462

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 44006000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43083000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41854500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41522000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".