Provider Demographics
NPI:1144241027
Name:DIANA LAMPSA MDSC
Entity Type:Organization
Organization Name:DIANA LAMPSA MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-683-9500
Mailing Address - Street 1:1425 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-6707
Mailing Address - Country:US
Mailing Address - Phone:920-683-9500
Mailing Address - Fax:
Practice Address - Street 1:1425 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6707
Practice Address - Country:US
Practice Address - Phone:920-683-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30802000Medicaid