1972610541 NPI number — THE CAMBRIGE GROUP INC.

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 1972610541 NPI number — THE CAMBRIGE GROUP INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CAMBRIGE GROUP 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:
NONE
Provider Other Organization Name Type Code:
3
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:
1972610541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6110 N PORT WASHINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53217-4308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-332-7400
Provider Business Mailing Address Fax Number:
414-963-6866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6110 N. PORT WASHINGTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
53217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-332-7400
Provider Business Practice Location Address Fax Number:
414-963-6866
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMERZ
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
414-332-7400

Provider Taxonomy Codes

  • Taxonomy code: 320800000X , with the licence number:  1404-057 , 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: 42176000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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