Healthcare Provider Details

I. General information

NPI: 1932161783
Provider Name (Legal Business Name): ASSOCIATED EMERGENCY ROOM PHYSICANS, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 MCHENRY ST
BURLINGTON WI
53105-1828
US

IV. Provider business mailing address

9875 S FRANKLIN DR
FRANKLIN WI
53132-8895
US

V. Phone/Fax

Practice location:
  • Phone: 262-767-6100
  • Fax: 262-767-6098
Mailing address:
  • Phone: 414-858-2206
  • Fax: 414-858-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JILL W HAYSSEN
Title or Position: BILLING MANAGER
Credential:
Phone: 414-858-2206