1457914301 NPI number — ANEWU LLC

Table of content: (NPI 1457914301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457914301 NPI number — ANEWU LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANEWU 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:
1457914301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 639
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THIENSVILLE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53092-0639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-247-9005
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 GREEN BAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THIENSVILLE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53092-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-305-4046
Provider Business Practice Location Address Fax Number:
414-247-9004
Provider Enumeration Date:
04/17/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ARAUJO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
414-305-4046

Provider Taxonomy Codes

  • Taxonomy code: 207ZC0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 28823 . This is a "DR ARAUJO LICENSE NUMBER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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