1336247139 NPI number — MILWAUKEE HEALTH SERVICES SYSTEM, LLC

Table of content: (NPI 1336247139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336247139 NPI number — MILWAUKEE HEALTH SERVICES SYSTEM, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILWAUKEE HEALTH SERVICES SYSTEM, 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:
6
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:
1336247139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6183 PASEO DEL NORTE
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92011-1155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-259-2288
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 WASHINGTON ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUSAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54403-5475
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-845-3637
Provider Business Practice Location Address Fax Number:
715-845-1977
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FARLEY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
PHILLIP
Authorized Official Title or Position:
VP & SECRETARY
Authorized Official Telephone Number:
615-861-6000

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X , with the licence number:  2408 , 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: 10005631 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43030000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39380300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43701100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34657600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39350000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42024500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42020800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42229200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42015800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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