1386983930 NPI number — CHILDREN'S HOSPITAL OF WISCONSIN

Table of content: DR. JOHN DERRICK HARNESS D.P.M. (NPI 1649272493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386983930 NPI number — CHILDREN'S HOSPITAL OF WISCONSIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HOSPITAL OF 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:
CHILD ADVOCACY CENTER - GREEN BAY
Provider Other Organization Name Type Code:
5
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:
1386983930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9000 W WISCONSIN AVE
Provider Second Line Business Mailing Address:
MS 958
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-4874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-266-7615
Provider Business Mailing Address Fax Number:
414-266-6238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 S MONROE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54301-4017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-436-8881
Provider Business Practice Location Address Fax Number:
920-436-4413
Provider Enumeration Date:
02/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GAGE
Authorized Official First Name:
WELDON
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER/CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
414-266-6401

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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