Active NPI
Lawrence C Sandberg, PT
- General Acute Care Hospital
- Kenosha, WI
National Provider Identifier
1922145648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Acute Care Hospital
- License
- 2065-024
- Practice address
- 6308 8TH Ave
Kenosha, WI 53143-5031 - Phone
- (262) 656-3290
- NPI assigned
- Jan 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 2065-024 | WI | Primary |
Addresses
Primary practice location
6308 8TH Ave
Kenosha, WI 53143-5031
Mailing address
2123 Ramada Dr
Racine, WI 53406-2220
Phone (262) 886-0463
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2065-024 | WI | MD | General Acute Care Hospital |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170201600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1922145648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2123 RAMADA DR",
"city": "RACINE",
"state": "WI",
"postal_code": "534062220",
"telephone_number": "262-886-0463"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6308 8TH AVE",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531435031",
"telephone_number": "262-656-3290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDBERG",
"first_name": "LAWRENCE",
"middle_name": "C",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "282N00000X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital",
"state": "WI",
"license": "2065-024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.