NPIMap

Organization Active NPI

Froedtert & the Medical College of Wisconsin Community Physicians

Doing business as Potawatomi Workplace Clinic

  • Non-Pharmacy Dispensing Site
  • Milwaukee, WI
National Provider Identifier
1801373378
Registry record updated Jul 26, 2018
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
Doing business as
Potawatomi Workplace Clinic
Practice address
1721 W Canal St
Milwaukee, WI 53233
Phone
(414) 454-8480
NPI assigned
Jul 26, 2018
Last updated
Jul 26, 2018By 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 Jul 26, 2018

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

1721 W Canal St
Milwaukee, WI 53233

Mailing address

W129N7055 Northfield Dr
Menomonee Falls, WI 53051-0538
Phone (262) 253-5102

Other names 1

  • Potawatomi Workplace Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Froedtert Med Coll Wi Comm19 organizations share this tax ID, including this one
Part of
Froedtert Med Coll Wi Comm

Other organizations with this tax ID 18

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

View all 18

Locations

1721 W Canal St
Milwaukee, WI 53233
Phone (414) 454-8480

NPI Registry JSON

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

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532563200000",
    "number": "1801373378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W129N7055 NORTHFIELD DR",
            "city": "MENOMONEE FALLS",
            "state": "WI",
            "postal_code": "530510538",
            "telephone_number": "262-253-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 W CANAL ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53233",
            "telephone_number": "414-454-8480"
        }
    ],
    "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": "2018-07-26",
        "last_updated": "2018-07-26",
        "status": "A",
        "authorized_official_last_name": "NEWMAN",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "VP 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": [
        {
            "organization_name": "Potawatomi Workplace Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 26, 2018; 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.