NPIMap

Organization Active NPI

Froedtert & the Medical College of Wisconsin Community Physicians

  • Non-Pharmacy Dispensing Site
  • Mequon, WI
National Provider Identifier
1780142992
Registry record updated Mar 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS
Practice address
11040 N Range Line Rd
Mequon, WI 53092-4930
Phone
(262) 253-5230
NPI assigned
Mar 6, 2019
Last updated
Mar 6, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2019

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

Authorized official

Name
Randall Newman
Title
VP of Finance
Phone
(414) 777-7963

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X NU Primary

Addresses

Primary practice location

11040 N Range Line Rd
Mequon, WI 53092-4930

Mailing address

11040 N Range Line Rd
Mequon, WI 53092-4930
Phone (262) 253-5230

National Provider Directory

National Provider Directory
Tax ID family
Froedtert the Med College19 organizations share this tax ID, including this one
Part of
Froedtert the Med College

Other organizations with this tax ID 18

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

View all 18

Locations

11040 N Range Line Rd
Mequon, WI 53092
Phone (262) 253-5230

NPI Registry JSON

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

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551830400000",
    "number": "1780142992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11040 N RANGE LINE RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530924930",
            "telephone_number": "262-253-5230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11040 N RANGE LINE RD",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530924930",
            "telephone_number": "262-253-5230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FROEDTERT & THE MEDICAL COLLEGE OF WISCONSIN COMMUNITY PHYSICIANS",
        "enumeration_date": "2019-03-06",
        "last_updated": "2019-03-06",
        "status": "A",
        "authorized_official_last_name": "NEWMAN",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "414-777-7963"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mequon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; 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.