Basic Information
| Provider Information | |||||||||
| NPI: | 1679694004 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GI SPECIALISTS LLC | ||||||||
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| OtherOrganizationName: | MORELAND ENDOSCOPY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 W KINNICKINNIC RIVER PKWY STE 1080 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532153689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149086601 | ||||||||
| FaxNumber: | 4143852980 | ||||||||
| Practice Location | |||||||||
| Address1: | 1111 DELAFIELD ST | ||||||||
| Address2: | SUITE 322 | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531883417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625448622 | ||||||||
| FaxNumber: | 2625448630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | MARQUEZ | ||||||||
| AuthorizedOfficialFirstName: | NICOLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4149086601 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | P00658029 | 01 | WI | RAILROAD MEDICARE | OTHER | 000085213 | 01 | WI | MEDICARE PTAN | OTHER |