Provider Demographics
NPI:1972537223
Name:SYMMETRY PAIN & WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:SYMMETRY PAIN & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SOCRATES
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-856-1970
Mailing Address - Street 1:200 E RYAN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-4533
Mailing Address - Country:US
Mailing Address - Phone:414-856-1970
Mailing Address - Fax:414-856-1974
Practice Address - Street 1:200 E RYAN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-4533
Practice Address - Country:US
Practice Address - Phone:414-856-1970
Practice Address - Fax:414-856-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0708835OtherUNITED HEALTHCARE
WI169347163655OtherHUMANA
WI56823050OtherFIRST HEALTH
WI=========018OtherCOMPCARE BLUE
WI56823050OtherFIRST HEALTH
WI=========OtherUNITED HEALTHCARE
WI=========OtherFISERV HEALTH
WI=========OtherNGS BEECH STREET CORP
WI=========OtherMEI WAUSAU
WI=========OtherHEALTH EOS
WI=========OtherTOTAL CLAIMS SOLUTIONS
WI=========018OtherANTHEM
WI=========018OtherBLUE CROSS BLUE SHIELD PP
WI169347163655OtherHUMANA