1063780658 NPI number — LIFEVIEW CARE WISCONSIN S.C.

Table of content: (NPI 1063780658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063780658 NPI number — LIFEVIEW CARE WISCONSIN S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEVIEW CARE WISCONSIN S.C.
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:
1063780658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 S WHITNEY WAY
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:
53711-2553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-500-3337
Provider Business Mailing Address Fax Number:
855-715-1907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 AMERICAN BLVD W STE 225
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMINGTON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55431-4527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-500-3337
Provider Business Practice Location Address Fax Number:
855-715-1907
Provider Enumeration Date:
12/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HARMAN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
952-500-3337

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1609853530 . This is a "PROVIDER NPI" identifier . This identifiers is of the category "OTHER".




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