Provider Demographics
NPI:1982654091
Name:VIVENT HEALTH INC
Entity Type:Organization
Organization Name:VIVENT HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR OF CORPORATE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-225-1568
Mailing Address - Street 1:PO BOX 18412
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-8412
Mailing Address - Country:US
Mailing Address - Phone:866-525-5484
Mailing Address - Fax:414-225-1575
Practice Address - Street 1:1311 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-4006
Practice Address - Country:US
Practice Address - Phone:866-525-5484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32895000Medicaid
WI42228200Medicaid
WI38390700Medicaid
WI43089200Medicaid
WI32405Medicare ID - Type UnspecifiedMULTI-SPECIALTY CLINIC
WI38390700Medicaid