1063579381 NPI number — AEGIS 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 1063579381 NPI number — AEGIS GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AEGIS 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:
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:
1063579381
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1765 ALLOUEZ AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54311-5645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-469-9779
Provider Business Mailing Address Fax Number:
920-469-9777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1765 ALLOUEZ AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54311-5645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-469-9779
Provider Business Practice Location Address Fax Number:
920-469-9777
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MADIGAN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
920-469-9779

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  6001266 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416A0800X , with the licence number: 6001266 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X , with the licence number: 6001266 , 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: 4755776 TYPE 18 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4755794 TYPE 18 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41312700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590001468 . This is a "RR MEDICARE AIR AMBULANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 41357800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590001468 . This is a "RR MEDICARE GROUND AMBULA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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