Healthcare Provider Details

I. General information

NPI: 1205301850
Provider Name (Legal Business Name): ANESTHESIA MANAGEMENT SOLUTIONS OF WISCONSIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2661 COUNTY HIGHWAY I
CHIPPEWA FALLS WI
54729-5407
US

IV. Provider business mailing address

PO BOX 6397
SPRINGFIELD IL
62708-6397
US

V. Phone/Fax

Practice location:
  • Phone: 800-232-5703
  • Fax:
Mailing address:
  • Phone: 800-232-5703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DAVID W SIMPSON
Title or Position: SOLE MEMBER
Credential: MD
Phone: 941-360-1566