Healthcare Provider Details

I. General information

NPI: 1427030279
Provider Name (Legal Business Name): EMERGENCY ROOM SPECIALISTS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19035 W CAPITOL DR SUITE 101
BROOKFIELD WI
53045-2706
US

IV. Provider business mailing address

6400 INDUSTRIAL LOOP
GREENDALE WI
53129-2452
US

V. Phone/Fax

Practice location:
  • Phone: 262-754-1421
  • Fax: 262-754-3760
Mailing address:
  • Phone: 414-423-4100
  • Fax: 414-423-4134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA FREEDY
Title or Position: VICE PRESIDENT - OPERATIONS
Credential:
Phone: 262-754-1421