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General NPI Number Information
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NPI Number | 1548606767
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Entity Type | Organization
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Legal Business Name | BYRON HEALTH AND HEALING CENTER
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 2405 NORTHWESTERN AVE LOWER LEVEL, STE 15
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City | RACINE
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State | WI
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Zip | 53404-2534
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Country | US
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Telephone | 262-498-3718
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Fax |
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Provider Business Mailing Address
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Address Line | 2405 NORTHWESTERN AVE LOWER LEVEL, STE 15
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City | RACINE
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State | WI
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Zip | 53404-2534
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Country | US
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Telephone | 262-498-3718
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JAMES K IRUNGU
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Credential |
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Telephone | 678-353-7073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 42218-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 42218-20
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License Number State | WI
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