1831246487 NPI number — NORTHEASTERN WISCONSIN WOMENS HEALTH CARE ASSOCIATES SC

Table of content: (NPI 1831246487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831246487 NPI number — NORTHEASTERN WISCONSIN WOMENS HEALTH CARE ASSOCIATES SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEASTERN WISCONSIN WOMENS HEALTH CARE ASSOCIATES 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:
1831246487
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:
835 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
OCONTO FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54154-1282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-846-9995
Provider Business Mailing Address Fax Number:
920-846-8031

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
OCONTO FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54154-1282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-846-9995
Provider Business Practice Location Address Fax Number:
920-846-8031
Provider Enumeration Date:
01/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOWERS
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
920-846-9995

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  50013 , 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: 1750384913 . This is a "NPI PATERSON" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1518941418 . This is a "NPI BOWERS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".