1326232976 NPI number — HEART AND VASCULAR SPECIALISTS S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326232976 NPI number — HEART AND VASCULAR SPECIALISTS S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART AND VASCULAR SPECIALISTS 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:
1326232976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2801 W. KINNICKINNIC RIVER PKWY.
Provider Second Line Business Mailing Address:
SUITE 460
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53215-3695
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-389-7388
Provider Business Mailing Address Fax Number:
414-389-9069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 W. KINNICKINNIC RIVER PKWY.
Provider Second Line Business Practice Location Address:
SUITE 460
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53215-3695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-389-7388
Provider Business Practice Location Address Fax Number:
414-389-9069
Provider Enumeration Date:
08/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REMINGTON
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
NURSE PRACTITIONER/OFFICE MANAGER
Authorized Official Telephone Number:
414-389-7388

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  26467 - 020 , 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: 21258600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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