Provider Demographics
NPI:1841398591
Name:DIAGNOSTIC & TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC & TREATMENT CENTER, LLC
Other - Org Name:DIAGNOSTIC & SURGICAL SERVICE CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SENIOR DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHISNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-393-2499
Mailing Address - Street 1:3401 CRANBERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476
Mailing Address - Country:US
Mailing Address - Phone:715-393-2489
Mailing Address - Fax:715-241-9475
Practice Address - Street 1:3401 CRANBERRY BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476
Practice Address - Country:US
Practice Address - Phone:715-393-2489
Practice Address - Fax:715-241-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41226200Medicaid
WI41226200Medicaid