Provider Demographics
NPI:1245346733
Name:WISCONSIN PSYCHIATRIC SERVICES, LTD
Entity type:Organization
Organization Name:WISCONSIN PSYCHIATRIC SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WESS
Authorized Official - Middle Name:R
Authorized Official - Last Name:VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-512-9400
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-0639
Mailing Address - Country:US
Mailing Address - Phone:262-512-9400
Mailing Address - Fax:
Practice Address - Street 1:1035 W GLEN OAKS LN
Practice Address - Street 2:SUITE 204
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3392
Practice Address - Country:US
Practice Address - Phone:262-512-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI284145Medicare PIN
WI01533Medicare PIN