1417919275 NPI number — PADDOCK LAKE FAMILY PRACTICE, SC

Table of content: ALBERT YI TSIEN M.D. (NPI 1801953559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417919275 NPI number — PADDOCK LAKE FAMILY PRACTICE, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PADDOCK LAKE FAMILY PRACTICE, SC
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:
1417919275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7137 236TH AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53168-9664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-843-4422
Provider Business Mailing Address Fax Number:
262-843-1166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7137 236TH AVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53168-9664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-843-4422
Provider Business Practice Location Address Fax Number:
262-843-1166
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
LISA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
262-843-2394

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DD7478 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21291800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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