=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598032328
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREAT MIDWEST PAIN SPECIALISTS, S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2011
-----------------------------------------------------
Last Update Date | 09/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21150 W CAPITOL DR STE 4
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53072-2909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-366-0665
-----------------------------------------------------
Fax | 262-649-3226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 S EXECUTIVE DR
-----------------------------------------------------
City | BROOKFIELD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53005-4257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-787-4050
-----------------------------------------------------
Fax | 262-782-6040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEFFREY T. FOLLANSBEE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 262-617-7415
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 32725
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------