NPIMap

Organization Active NPI

Spine Center of Wisconsin SC

  • Medical Specialty Clinic/Center
  • Milwaukee, WI
National Provider Identifier
1467561506
Registry record updated Sep 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
19042 Issued in WI
Legal business name
SPINE CENTER OF WISCONSIN SC
Practice address
2801 W Kinnickinnic River Pkwy Ste 355
Milwaukee, WI 53215-3695
Phone
(414) 235-3623
Fax
(414) 235-3623
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2008

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

Authorized official

Name
Ms. Mary J Banach
Title
Ofc MGR
Phone
(414) 235-3623

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 19042 WI Primary
Radiology Clinic/Center 261QR0200X XM39276 WI
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

2801 W Kinnickinnic River Pkwy Ste 355
Milwaukee, WI 53215-3695

Mailing address

PO Box 320695
Franklin, WI 53132
Phone (414) 235-3623

Other identifiers 1

IdentifierTypeStateIssuer
30876700MedicaidWI

National Provider Directory

National Provider Directory

Locations

2801 W Kinnickinnic River Pkwy
Ste 355
Milwaukee, WI 53215
Phone (414) 235-3623

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221696000000",
    "number": "1467561506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 320695",
            "city": "FRANKLIN",
            "state": "WI",
            "postal_code": "53132",
            "telephone_number": "414-235-3623",
            "fax_number": "414-235-3623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 W KINNICKINNIC RIVER PKWY STE 355",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532153695",
            "telephone_number": "414-235-3623",
            "fax_number": "414-235-3623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE CENTER OF WISCONSIN SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2008-09-18",
        "status": "A",
        "authorized_official_last_name": "BANACH",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFC MGR",
        "authorized_official_telephone_number": "414-235-3623",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "WI",
            "license": "19042",
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "WI",
            "license": "XM39276",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30876700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2008; 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.