Provider Demographics
NPI:1790537546
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:608-291-4866
Mailing Address - Street 1:PPW MADISON DME
Mailing Address - Street 2:2500 WEST LAYTON AVENUE, SUITE 120
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2528
Mailing Address - Country:US
Mailing Address - Phone:262-297-7246
Mailing Address - Fax:888-714-0578
Practice Address - Street 1:34 SCHROEDER CT STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2528
Practice Address - Country:US
Practice Address - Phone:262-297-7246
Practice Address - Fax:888-714-0578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN PHYSICIANS OF WISCONSIN, SC
Parent Organization TIN:<UNAVAIL>
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