Provider Demographics
NPI:1609628411
Name:PAIN PHYSICIANS OF WISCONSIN, SC
Entity Type:Organization
Organization Name:PAIN PHYSICIANS OF WISCONSIN, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEARDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-297-7246
Mailing Address - Street 1:2500 W LAYTON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-5400
Mailing Address - Country:US
Mailing Address - Phone:262-297-7246
Mailing Address - Fax:888-714-0578
Practice Address - Street 1:4202 W OAKWOOD PARK CT STE 110
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9565
Practice Address - Country:US
Practice Address - Phone:262-297-7246
Practice Address - Fax:888-714-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies