1609876655 NPI number — ARIZCONSIN GROUP INC

Table of content: (NPI 1609876655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609876655 NPI number — ARIZCONSIN GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARIZCONSIN 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:
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:
1609876655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANDON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54520-0400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-478-3324
Provider Business Mailing Address Fax Number:
715-478-5085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 W PIONEER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANDON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54520-1554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-478-3324
Provider Business Practice Location Address Fax Number:
715-478-5085
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RAU
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
I
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
715-478-3324

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2945 , 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: 20124900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2945 . This is a "FACIOLITY LICENSE NUMBER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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