1477525715 NPI number — MILWAUKEE ASC LLC

Table of content: MR. KENT K. SETSER ARNP (NPI 1659766392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477525715 NPI number — MILWAUKEE ASC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILWAUKEE ASC 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:
MILWAUKEE ENDOSCOPY CENTER
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:
1477525715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8585 W FOREST HOME AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53228-3417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-427-5138
Provider Business Mailing Address Fax Number:
414-427-5145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8585 W FOREST HOME AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53228-3417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-427-5138
Provider Business Practice Location Address Fax Number:
414-427-5145
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLENDENIN
Authorized Official First Name:
PHILLIP
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-665-1283

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  NONE REQUIRED , 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: 41909300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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