Provider Demographics
NPI:1326232976
Name:HEART AND VASCULAR SPECIALISTS S.C.
Entity Type:Organization
Organization Name:HEART AND VASCULAR SPECIALISTS S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:REMINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:414-389-7388
Mailing Address - Street 1:2801 W. KINNICKINNIC RIVER PKWY.
Mailing Address - Street 2:SUITE 460
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3695
Mailing Address - Country:US
Mailing Address - Phone:414-389-7388
Mailing Address - Fax:414-389-9069
Practice Address - Street 1:2801 W. KINNICKINNIC RIVER PKWY.
Practice Address - Street 2:SUITE 460
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3695
Practice Address - Country:US
Practice Address - Phone:414-389-7388
Practice Address - Fax:414-389-9069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26467 - 020174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21258600Medicaid
WI21258600Medicaid