Provider Demographics
NPI:1972568129
Name:ST. JOSEPH'S ELECTROCARDIOGRAPHIC ASSOCIATES
Entity Type:Organization
Organization Name:ST. JOSEPH'S ELECTROCARDIOGRAPHIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-427-7820
Mailing Address - Street 1:PO BOX 934
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-0934
Mailing Address - Country:US
Mailing Address - Phone:414-427-7820
Mailing Address - Fax:
Practice Address - Street 1:5000 W CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1650
Practice Address - Country:US
Practice Address - Phone:414-427-7820
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI1337OtherRR MEDICARE
WI32698800Medicaid