1952860181 NPI number — SYMETRIA HEALTH OF WISCONSIN, L.L.C.

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 1952860181 NPI number — SYMETRIA HEALTH OF WISCONSIN, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYMETRIA HEALTH OF WISCONSIN, L.L.C.
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:
1952860181
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 SHUMAN BLVD
Provider Second Line Business Mailing Address:
SUITE 262
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-782-6966
Provider Business Mailing Address Fax Number:
630-870-1284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6080 S 108TH ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALES CORNERS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53130-2557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-782-6966
Provider Business Practice Location Address Fax Number:
630-870-1284
Provider Enumeration Date:
03/18/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HASSAN
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
888-782-6966

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com