1710940465 NPI number — HYPERBARIC AND WOUND CARE ASSOCIATES, SC

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 1710940465 NPI number — HYPERBARIC AND WOUND CARE ASSOCIATES, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HYPERBARIC AND WOUND CARE ASSOCIATES, 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:
1710940465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9875 S FRANKLIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53132-8895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-858-2206
Provider Business Mailing Address Fax Number:
414-858-2236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 W OKLAHOMA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53215-4330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-385-8723
Provider Business Practice Location Address Fax Number:
414-385-8721
Provider Enumeration Date:
04/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYSSEN
Authorized Official First Name:
JILL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
414-858-2206

Provider Taxonomy Codes

  • Taxonomy code: 207PE0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 71142 . This is a "MEDICARE ID" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 32882200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32005 . This is a "MEDICARE ID" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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