Provider Demographics
NPI: | 1932819505 |
---|---|
Name: | WEST SUBURBAN CTR FOR ARTHRITIS |
Entity Type: | Organization |
Organization Name: | WEST SUBURBAN CTR FOR ARTHRITIS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OFFICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | AMY |
Authorized Official - Middle Name: | B |
Authorized Official - Last Name: | HEHN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 262-785-1964 |
Mailing Address - Street 1: | 601 N BARKER RD STE 110 |
Mailing Address - Street 2: | |
Mailing Address - City: | BROOKFIELD |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 53045-5929 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 262-785-1964 |
Mailing Address - Fax: | 262-785-8029 |
Practice Address - Street 1: | 601 N BARKER RD STE 110 |
Practice Address - Street 2: | |
Practice Address - City: | BROOKFIELD |
Practice Address - State: | WI |
Practice Address - Zip Code: | 53045-5929 |
Practice Address - Country: | US |
Practice Address - Phone: | 262-785-1964 |
Practice Address - Fax: | 262-785-8029 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-12-05 |
Last Update Date: | 2022-12-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332900000X | Suppliers | Non-Pharmacy Dispensing Site |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WI | 32805700 | Medicaid |