NPIMap

Organization Active NPI

Affiliated Clinical Services Inc

  • Multi-Specialty Clinic/Center
  • West Bend, WI
National Provider Identifier
1851473698
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
AFFILIATED CLINICAL SERVICES INC
Practice address
111 E Washington St
West Bend, WI 53095-2571
Phone
(262) 338-2717
Fax
(262) 338-9767
NPI assigned
Oct 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Kelli Feucht
Title
Assistant Business Manager
Phone
(262) 338-2717

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

111 E Washington St
West Bend, WI 53095-2571

Mailing address

111 E Washington St
West Bend, WI 53095-2571
Phone (262) 338-2717

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040212000835 WI Part B Supplier - Clinic/Group Practice 0244124899 Receives reassigned benefits from 33 practitioners
Practice locations: West Bend, WI; Hartford, WI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2019162Affiliated Clinical Services111 E Washington St, West Bend, WI 53095Certificate of waiverJan 23, 2027

National Provider Directory

National Provider Directory

Locations

400 N Riv Rd
West Bend, WI 53090
Phone (262) 338-2717

111 E Washington St
West Bend, WI 53095
Phone (262) 338-2717

Practitioners & affiliated clinicians

Practitioners 102

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 102

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1851473698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E WASHINGTON ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952571",
            "telephone_number": "262-338-2717",
            "fax_number": "262-338-9767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E WASHINGTON ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952571",
            "telephone_number": "262-338-2717",
            "fax_number": "262-338-9767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFILIATED CLINICAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "FEUCHT",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "ASSISTANT BUSINESS MANAGER",
        "authorized_official_telephone_number": "262-338-2717"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bend, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.