NPIMap

Organization Active NPI

Children'S Hospital of Wisconsin

  • Pediatrics Physician
  • Racine, WI
National Provider Identifier
1194064865
Registry record updated Sep 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CHILDREN'S HOSPITAL OF WISCONSIN
Practice address
2405 Northwestern Ave
Suite 205
Racine, WI 53404-2534
Phone
(262) 898-7970
Fax
(262) 898-6621
NPI assigned
Jan 31, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Weldon Gage
Title
Credentialing Coordinator
Phone
(414) 266-6401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

2405 Northwestern Ave
Suite 205
Racine, WI 53404-2534

Mailing address

9000 W Wisconsin Ave
Ms 958
Milwaukee, WI 53226-4874
Phone (414) 266-7615

Other names 1

  • Child Advocacy Center - Racine Other name

National Provider Directory

National Provider Directory
Tax ID family
Children'S Hospital of Wisconsin Inc-Fox Valley22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1359590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380240000000",
    "number": "1194064865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "MS 958",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-7615",
            "fax_number": "414-266-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 NORTHWESTERN AVE",
            "address_2": "SUITE 205",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534042534",
            "telephone_number": "262-898-7970",
            "fax_number": "262-898-6621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S HOSPITAL OF WISCONSIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-31",
        "last_updated": "2013-09-27",
        "status": "A",
        "authorized_official_last_name": "GAGE",
        "authorized_official_first_name": "WELDON",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "414-266-6401"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Child Advocacy Center - Racine",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Racine, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.