1699719476 NPI number — WISCONSIN MICHIGAN PHYSICIANS, SC

Table of content: (NPI 1699719476)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699719476 NPI number — WISCONSIN MICHIGAN PHYSICIANS, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WISCONSIN MICHIGAN PHYSICIANS, SC
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:
1699719476
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 ROOSEVELT RD
Provider Second Line Business Mailing Address:
PO BOX 6
Provider Business Mailing Address City Name:
NIAGARA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54151-1043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-251-1780
Provider Business Mailing Address Fax Number:
715-251-1787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 ROOSEVELT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIAGARA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54151-1043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-225-1780
Provider Business Practice Location Address Fax Number:
715-251-1787
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SINGH
Authorized Official First Name:
FRANCOISE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
888-724-6377

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  34886 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 746200001 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: CD6737 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: CD6736 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 050B210120 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 21329700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110B210270 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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