Provider Demographics
NPI:1912959156
Name:RJC MEDICAL SERVICES, S.C.
Entity Type:Organization
Organization Name:RJC MEDICAL SERVICES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-951-8508
Mailing Address - Street 1:PO BOX 1423
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53187-1423
Mailing Address - Country:US
Mailing Address - Phone:262-951-8508
Mailing Address - Fax:262-565-0340
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 219
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3403
Practice Address - Country:US
Practice Address - Phone:262-951-8508
Practice Address - Fax:262-565-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21299100Medicaid
WIB52195Medicare UPIN