Provider Demographics
NPI:1649247743
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:VICE PRESIDENT OF BUSINESS DEVELOPM
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:314-443-6607
Mailing Address - Street 1:2400 WEST VILLARD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53029-4999
Mailing Address - Country:US
Mailing Address - Phone:414-527-7120
Mailing Address - Fax:414-527-7121
Practice Address - Street 1:2400 WEST VILLARD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53029-4999
Practice Address - Country:US
Practice Address - Phone:414-527-7120
Practice Address - Fax:414-527-7121
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 Licenses
StateLicense IDTaxonomies
WI83960423336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33274700Medicaid
WI4895590004Medicare ID - Type Unspecified