NORTHWEST PEDIATRIC SPECIALTIES, INC. (NPI# 1366526956) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366526956 |
| Entity Type | Organization |
| Organization Name | NORTHWEST PEDIATRIC SPECIALTIES, INC. |
| Practice Address |
203 United Way Drive Frederic WI 54837-8938 |
| Practice Telephone | 7153274322 |
| Practice Fax Number | 7153278509 |
| Mailing Telephone | 7153274322 |
| Mailing Fax Number | 7153278509 |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2012-03-27 |
| Authorized Official Name | JACKIE J MAURER (BUSINESS OFFICE SUPERVISOR) |
| Authorized Official Telephone | 7153274322 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 33148-020 | WI | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32847900 | 05 |
| Street Address |
203 UNITED WAY DRIVE |
| City | FREDERIC |
| State | WI |
| Zip Code | 54837-8938 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235266065 | Northwest Passage Ltd | Residential Treatment Facility, Emotionally Disturbed Children | 203 United Way Drive, Frederic, WI 54837-8938 | 2007-02-28 |
| 1710022298 | Cynthia L Boykin | Psychologist | 203 United Way Drive, Frederic, WI 54837-8938 | 2007-02-21 |
| 1225173644 | Tara L Mitchell | Counselor | 203 United Way Drive, Frederic, WI 54837-8938 | 2007-02-21 |
| 1619002839 | Timothy D Newlin | Counselor | 203 United Way Drive, Frederic, WI 54837-8938 | 2007-02-21 |
| 1104990530 | Northwest Counseling & Guidance Clinic | Clinic/Center | 203 United Way Drive, Frederic, WI 54837-8938 | 2006-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548639636 | Austin Ross | Pharmacist | 201 Oak St West, Frederic, WI 54837 | 2015-09-18 |
| 1811256126 | St. Croix Regional Medical Center | Clinic/Center | 205 West Oak Street, Frederic, WI 54837 | 2012-05-07 |
| 1447497763 | Saint-mark Enterprises 1855 LLC | Durable Medical Equipment & Medical Supplies | 110 E Oak St, Frederic, WI 54837 | 2009-01-08 |
| 1639263221 | Pharmacy Operations Inc | Pharmacy | 110 E Oak Street, Frederic, WI 54837 | 2006-10-03 |
| 1457338139 | Joseph L Marek | Chiropractor | 101 United Way, Frederic, WI 54837 | 2005-12-23 |
| 1669572590 | Steven Richard Tesch | Dentist | 106 S Wisconsin Ave, Frederic, WI 54837-0250 | 2006-09-22 |
| 1306946223 | Bradley Scott Harlander | Dentist | 106 S Wisconsin Ave, Frederic, WI 54837-0250 | 2006-09-22 |
| 1689004426 | Kristina M Thompson | Social Worker | 107 Hope Road West, Frederic, WI 54837-0383 | 2013-11-14 |
| 1588158679 | Hope Road Wellness Center, LLC | Social Worker | 107 Hope Road West, Frederic, WI 54837-0383 | 2018-06-21 |
| 1043499734 | School District of Frederic | Local Education Agency (LEA) | 1437 Clam Falls Dr, Frederic, WI 54837-4547 | 2007-10-30 |
| Find all providers in zip 54837 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043835440 | Michael Dale Shoultz | Specialist | 2622 Hoard St, Madison, WI 53704-4827 | 2020-06-11 |
| 1134752934 | Denise Douglass | Specialist | 31 Northstar Ln, Saint Croix Falls, WI 54024-9005 | 2020-02-20 |
| 1164065025 | Susan Jane Janz | Specialist | 1014 W Thomas St, Wausau, WI 54401-5986 | 2019-10-23 |
| 1518508803 | Cheryl Ann Johnson | Specialist | 830 Edgewood Dr., Green Bay, WI 54311 | 2019-10-08 |
| 1982161048 | Natalia Roman | Specialist | 725 W Lapham Blvd Apt 17, Milwaukee, WI 53204-3447 | 2019-02-25 |
| 1598231524 | Shanel Marie Jordan | Specialist | 4827 N 76th St, Milwaukee, WI 53218-3826 | 2018-10-17 |
| 1386191799 | Dallas Roger Loukes | Specialist | 323 W Monroe St, Wyocena, WI 53969 | 2016-09-01 |
| 1285084368 | Madison Swim Academy | Specialist | 605 Chase Blvd, Sun Prairie, WI 53590-2382 | 2016-06-20 |
| 1851745905 | Kristyn Zahorik | Specialist | 7515 W Coldspring Rd, Greenfield, WI 53220-2814 | 2016-04-14 |
| 1104297274 | Andrea Renee Keapproth | Specialist | 433 W Washington Ave, Madison, WI 53703-3482 | 2015-10-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.