NPIMap

Organization Active NPI

Barry M Altenberg MD SC

  • Clinic/Center
  • Racine, WI
National Provider Identifier
1669565347
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
WI15872 Issued in WI
Legal business name
BARRY M ALTENBERG MD SC
Practice address
5802 Washington Ave
Racine, WI 53406
Phone
(262) 886-5700
Fax
(262) 886-4747
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Dr. Barry M Altenberg, MD
Title
Owner/President
Phone
(262) 898-7100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X WI15872 WI Primary

Addresses

Primary practice location

5802 Washington Ave
Racine, WI 53406

Mailing address

1055 Prairie Dr
Suite D
Racine, WI 53406
Phone (262) 898-7100

Other identifiers 2

IdentifierTypeStateIssuer
31175300MedicaidWI
32891300MedicaidWI

Other names 1

  • ALTENBERG CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Altenberg Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1669565347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 PRAIRIE DR",
            "address_2": "SUITE D",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "53406",
            "telephone_number": "262-898-7100",
            "fax_number": "262-898-7171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5802 WASHINGTON AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "53406",
            "telephone_number": "262-886-5700",
            "fax_number": "262-886-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARRY M ALTENBERG MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "ALTENBERG",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "262-898-7100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": "WI15872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31175300",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32891300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ALTENBERG CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 25, 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.