NPIMap

Organization Active NPI

Wisconsin Spine and Pain SC

  • Durable Medical Equipment & Medical Supplies
  • Waukesha, WI
National Provider Identifier
1487472593
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
WISCONSIN SPINE AND PAIN SC
Practice address
2607 N Grandview Blvd
Waukesha, WI 53188-1686
Phone
(920) 204-6758
NPI assigned
Sep 27, 2024
Last updated
Sep 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Authorized official

Name
Michael JungNPI 1861665747
Title
Owner
Phone
(414) 455-1153

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

2607 N Grandview Blvd
Waukesha, WI 53188-1686

Mailing address

Dept. CH 17057
Palatine, IL 60055-7057
Phone (920) 204-6758

National Provider Directory

National Provider Directory
Tax ID family
Wisconsin Spine and Pain SC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1727395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727395200000",
    "number": "1487472593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT. CH 17057",
            "city": "PALATINE",
            "state": "IL",
            "postal_code": "600557057",
            "telephone_number": "920-204-6758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2607 N GRANDVIEW BLVD",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531881686",
            "telephone_number": "920-204-6758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN SPINE AND PAIN SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-27",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A",
        "authorized_official_last_name": "JUNG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "414-455-1153"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukesha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.