1578612081 NPI number — CAMEO CARE CENTER INC.

Table of content: KIMBERLY JILL BAIER CRNA (NPI 1871818468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578612081 NPI number — CAMEO CARE CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMEO CARE CENTER 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:
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:
1578612081
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5790 S 27TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53221-4129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-282-1300
Provider Business Mailing Address Fax Number:
414-282-9211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5790 S 27TH ST
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:
53221-4129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-282-1300
Provider Business Practice Location Address Fax Number:
414-282-9211
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRESOVIC
Authorized Official First Name:
BORISLAV
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
414-282-1300

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2230 , 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: 20148400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com