Healthcare Provider Details

I. General information

NPI: 1376624320
Provider Name (Legal Business Name): RI-LEE MEDICAL STAFFING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 W MAIN ST
CAMERON WI
54822-4910
US

IV. Provider business mailing address

PO BOX 144
CAMERON WI
54822-0144
US

V. Phone/Fax

Practice location:
  • Phone: 715-458-3124
  • Fax: 715-458-3125
Mailing address:
  • Phone: 715-458-3124
  • Fax: 715-458-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1845
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1673
License Number StateWI

VIII. Authorized Official

Name: JAMES PATRICK FOGARTY
Title or Position: CEO
Credential: M.D.
Phone: 715-455-3124