Provider Demographics
NPI:1649247735
Name:WHEATON FRANCISCAN HOLDINGS, INC.
Entity type:Organization
Organization Name:WHEATON FRANCISCAN HOLDINGS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER ELLIPTICARE LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-872-5560
Mailing Address - Street 1:17000 W NORTH AVENUE
Mailing Address - Street 2:STE 100E
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4430
Mailing Address - Country:US
Mailing Address - Phone:262-785-7700
Mailing Address - Fax:262-785-7710
Practice Address - Street 1:17000 W NORTH AVENUE
Practice Address - Street 2:STE 100E
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4430
Practice Address - Country:US
Practice Address - Phone:262-785-7700
Practice Address - Fax:262-785-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33279400Medicaid
WI4895590006Medicare ID - Type Unspecified