1790537546 NPI number — PAIN PHYSICIANS OF WISCONSIN, SC

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 1790537546 NPI number — PAIN PHYSICIANS OF WISCONSIN, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN PHYSICIANS OF WISCONSIN, 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:
1790537546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PPW MADISON DME
Provider Second Line Business Mailing Address:
2500 WEST LAYTON AVENUE, SUITE 120
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53221-2528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-297-7246
Provider Business Mailing Address Fax Number:
888-714-0578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 SCHROEDER CT STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53711-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-297-7246
Provider Business Practice Location Address Fax Number:
888-714-0578
Provider Enumeration Date:
04/04/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BEARDSLEY
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
608-291-4866

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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