Provider Demographics
NPI:1568538189
Name:SOUTHERN WISCONSIN EMERGENCY ASSOCIATES SC
Entity Type:Organization
Organization Name:SOUTHERN WISCONSIN EMERGENCY ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:OLEKSYN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-551-1846
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53547-0431
Mailing Address - Country:US
Mailing Address - Phone:405-696-7932
Mailing Address - Fax:
Practice Address - Street 1:1969 W HART RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2230
Practice Address - Country:US
Practice Address - Phone:405-696-7932
Practice Address - Fax:608-758-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32789100Medicaid
WI32789100Medicaid