Provider Demographics
NPI:1548606767
Name:BYRON HEALTH AND HEALING CENTER
Entity Type:Organization
Organization Name:BYRON HEALTH AND HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:IRUNGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-353-7073
Mailing Address - Street 1:2405 NORTHWESTERN AVE
Mailing Address - Street 2:LOWER LEVEL, STE 15
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53404-2534
Mailing Address - Country:US
Mailing Address - Phone:262-498-3718
Mailing Address - Fax:
Practice Address - Street 1:2405 NORTHWESTERN AVE
Practice Address - Street 2:LOWER LEVEL, STE 15
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53404-2534
Practice Address - Country:US
Practice Address - Phone:262-498-3718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42218-20207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty