1881849016 NPI number — ACS CLINICAL SERVICES LLC

Table of content: (NPI 1881849016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881849016 NPI number — ACS CLINICAL SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACS CLINICAL SERVICES 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:
1881849016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53707-7370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-223-0017
Provider Business Mailing Address Fax Number:
608-223-0019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 W COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JANESVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53548-3811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-743-1736
Provider Business Practice Location Address Fax Number:
608-743-1759
Provider Enumeration Date:
12/02/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WAKEFIELD
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
DEVELOPMENT & QA OFFICER
Authorized Official Telephone Number:
608-223-0017

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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)