Healthcare Provider Details

I. General information

NPI: 1083918528
Provider Name (Legal Business Name): THE PROVIDERS' GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2010
Last Update Date: 12/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3429 N 1ST ST
MILWAUKEE WI
53212-1528
US

IV. Provider business mailing address

3429 N 1ST ST
MILWAUKEE WI
53212-1528
US

V. Phone/Fax

Practice location:
  • Phone: 414-732-8636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: TATIA P JACKSON
Title or Position: EXCUTIVE DIRECTOR
Credential:
Phone: 414-732-8636