1952418816 NPI number — ORTHOPEDIC & SPINE THERAPY OF OSHKOSH SC

Table of content: (NPI 1952418816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952418816 NPI number — ORTHOPEDIC & SPINE THERAPY OF OSHKOSH SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC & SPINE THERAPY OF OSHKOSH 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:
1952418816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 MIDWAY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENASHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54952-1116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-257-2000
Provider Business Mailing Address Fax Number:
920-257-2004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 OMRO RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSHKOSH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54904-7746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-232-4040
Provider Business Practice Location Address Fax Number:
920-232-4042
Provider Enumeration Date:
08/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARNETT
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
OWNER-PRESIDENT
Authorized Official Telephone Number:
920-257-2000

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , 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: 40416700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128848 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 369949305 . This is a "US DEPARTMENT OF LABOR" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 4136293002 . This is a "AMERICHOICE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 41745300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH3433 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com