Healthcare Provider Details

I. General information

NPI: 1487798740
Provider Name (Legal Business Name): MILWAUKEE REGIONAL MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2661 AVIATION RD
WAUKESHA WI
53188-6903
US

IV. Provider business mailing address

2661 AVIATION RD
WAUKESHA WI
53188-6903
US

V. Phone/Fax

Practice location:
  • Phone: 414-778-4570
  • Fax: 414-778-5431
Mailing address:
  • Phone: 414-778-4570
  • Fax: 414-778-5431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number9 792301
License Number StateIL

VIII. Authorized Official

Name: JOHN SMEATON
Title or Position: CONTROLLER
Credential:
Phone: 414-778-5929