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General NPI Number Information
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NPI Number | 1194727941
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Entity Type | Organization
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Legal Business Name | ENDEAVOR TESTING CENTER LLC
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 11649 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53092-3460
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Country | US
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Telephone | 262-241-8022
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Fax | 262-241-8047
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Provider Business Mailing Address
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Address Line | 11649 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53092-3460
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Country | US
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Telephone | 262-241-8022
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Fax | 262-241-8047
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. KAREN IRENE BLOCK
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Credential |
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Telephone | 262-241-8892
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS1200X
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Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
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License Number |
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License Number State |
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