Basic Information
| Provider Information | |||||||||
| NPI: | 1932161783 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED EMERGENCY ROOM PHYSICANS, SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9875 S FRANKLIN DR | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531328895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148582206 | ||||||||
| FaxNumber: | 4148582236 | ||||||||
| Practice Location | |||||||||
| Address1: | 252 MCHENRY ST | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531051828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2627676100 | ||||||||
| FaxNumber: | 2627676098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HAYSSEN | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4148582206 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 21293200 | 05 | WI | MEDICAID |