NPIMap

Organization Active NPI

Divine Savior Healthcare, Inc.

  • Pharmacy
  • Portage, WI
National Provider Identifier
1710133095
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
8330-042 Issued in WI
Legal business name
DIVINE SAVIOR HEALTHCARE, INC.
Practice address
2817 New Pinery Rd
Portage, WI 53901-9257
Phone
(608) 742-4131
NPI assigned
Aug 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Authorized official

Name
Mr. Jerry M Yang
Title
SVP & Chief Financial Officer
Phone
(715) 847-2526

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 8330-042 WI Primary

Addresses

Primary practice location

2817 New Pinery Rd
Portage, WI 53901-9257

Mailing address

29980 Network PL
Chicago, IL 60673-1299
Phone (715) 847-2304

Other identifiers 1

IdentifierTypeStateIssuer
33113100MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Divine Savior Hosp9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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": "1219017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1710133095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29980 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731299",
            "telephone_number": "715-847-2304",
            "fax_number": "715-843-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 NEW PINERY RD",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539019257",
            "telephone_number": "608-742-4131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE SAVIOR HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-18",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A",
        "authorized_official_last_name": "YANG",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SVP & CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "715-847-2526",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WI",
            "license": "8330-042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33113100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.