Provider Demographics
NPI:1235426461
Name:MATRIX MEDICAL NETWORK OF WISCONSIN, S.C.
Entity Type:Organization
Organization Name:MATRIX MEDICAL NETWORK OF WISCONSIN, S.C.
Other - Org Name:MATRIX MEDICAL NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-862-1695
Mailing Address - Street 1:9201 E MOUNTAIN VIEW
Mailing Address - Street 2:#220
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5172
Mailing Address - Country:US
Mailing Address - Phone:480-862-1700
Mailing Address - Fax:877-506-4560
Practice Address - Street 1:11414 W PARK PL STE 202
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3500
Practice Address - Country:US
Practice Address - Phone:480-862-1706
Practice Address - Fax:480-718-7643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty