1669914537 NPI number — NSH SUPERIOR LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669914537 NPI number — NSH SUPERIOR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NSH SUPERIOR 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:
TWIN PORTS HEALTH SERVICES
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:
1669914537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5150 N PORT WASHINGTON RD
Provider Second Line Business Mailing Address:
SUITE 260
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53217-5474
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-962-5250
Provider Business Mailing Address Fax Number:
414-962-5251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1612 N 37TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUPERIOR
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54880-5404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-392-5144
Provider Business Practice Location Address Fax Number:
715-392-1406
Provider Enumeration Date:
11/09/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HOEHN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
414-962-5250

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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