Provider Demographics
NPI:1942253950
Name:ST. CROIX WOMEN'S CENTER, S.C.
Entity Type:Organization
Organization Name:ST. CROIX WOMEN'S CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-381-9566
Mailing Address - Street 1:1610 MAXWELL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8709
Mailing Address - Country:US
Mailing Address - Phone:715-381-9566
Mailing Address - Fax:715-381-9588
Practice Address - Street 1:1610 MAXWELL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8709
Practice Address - Country:US
Practice Address - Phone:715-381-9566
Practice Address - Fax:715-381-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39295261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32338100Medicaid
MN773132900MNMedicaid
MN160002288Medicare PIN
WI32338100Medicaid