Healthcare Provider Details

I. General information

NPI: 1659903292
Provider Name (Legal Business Name): RACINE DIGESTIVE HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10340 WASHINGTON AVE STE 100
STURTEVANT WI
53177-1607
US

IV. Provider business mailing address

2801 W KINNICKINNIC RIVER PKWY STE 1080
MILWAUKEE WI
53215-3689
US

V. Phone/Fax

Practice location:
  • Phone: 414-908-6500
  • Fax: 414-908-6565
Mailing address:
  • Phone: 414-908-6506
  • Fax: 414-908-6510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY JO BURNS
Title or Position: DIRECTOR REVENUE CYCLE MANAGEMENT
Credential:
Phone: 262-970-7825