Provider Demographics
NPI:1619541661
Name:PHAROS ENTERPRISES OF WISCONSIN, LLC
Entity Type:Organization
Organization Name:PHAROS ENTERPRISES OF WISCONSIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-469-5536
Mailing Address - Street 1:2356 S 102ND ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2104
Mailing Address - Country:US
Mailing Address - Phone:262-689-8710
Mailing Address - Fax:
Practice Address - Street 1:2356 S 102ND ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2104
Practice Address - Country:US
Practice Address - Phone:262-689-8710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical