1689942393 NPI number — TMS CENTER OF WISCONSIN LLC

Table of content: OTHELLO SAYE KWAIDAH CRNP (NPI 1477051514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689942393 NPI number — TMS CENTER OF WISCONSIN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TMS CENTER OF WISCONSIN LLC
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:
1689942393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 N MAYFAIR RD STE 385
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUWATOSA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53226-1372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-251-0671
Provider Business Mailing Address Fax Number:
414-257-3588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 N MAYFAIR RD STE 385
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUWATOSA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-1372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-251-0671
Provider Business Practice Location Address Fax Number:
414-257-3588
Provider Enumeration Date:
12/08/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEMURI
Authorized Official First Name:
BERNADETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHIATRIST/OWNER
Authorized Official Telephone Number:
414-251-0671

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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