Provider Demographics
NPI:1164897872
Name:WISCONSIN TELEHEALTHCARE NETWORK
Entity Type:Organization
Organization Name:WISCONSIN TELEHEALTHCARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-416-8301
Mailing Address - Street 1:W146 S6974 CATALINA DRIVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150
Mailing Address - Country:US
Mailing Address - Phone:414-416-3801
Mailing Address - Fax:
Practice Address - Street 1:5600 W BROWN DEER RD
Practice Address - Street 2:SUITE 228
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-2311
Practice Address - Country:US
Practice Address - Phone:414-416-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261Q00000X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center