Basic Information
| Provider Information | |||||||||
| NPI: | 1588850150 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WISCONSIN SLEEP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7974 UW HEALTH COURT | ||||||||
| Address2: | |||||||||
| City: | MIDDLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535625531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088295485 | ||||||||
| FaxNumber: | 6088339201 | ||||||||
| Practice Location | |||||||||
| Address1: | 6001 RESEARCH PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537191176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082323301 | ||||||||
| FaxNumber: | 6082364521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2007 | ||||||||
| LastUpdateDate: | 12/18/2009 | ||||||||
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| AuthorizedOfficialLastName: | FLANNERY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP, FINANCE ADMINISTRATION | ||||||||
| AuthorizedOfficialTelephone: | 6088214223 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic |
ID Information
| ID | Type | State | Issuer | Description | P00749324 | 01 | WI | RAILROAD MEDICARE | OTHER |