| Waukesha Health System, Inc. | |
| 
					721 American Ave Suite 501 Waukesha WI 53188-5071  | |
| (262) 928-2396 | |
| (262) 544-1213 | 
| Full Name | Waukesha Health System, Inc. | 
|---|---|
| Speciality | Clinic/Center | 
| Location | 721 American Ave, Waukesha, Wisconsin | 
| Authorized Official Name and Position | Frederick L Syrjanen (EXECUTIVE DIRECTOR) | 
| Authorized Official Contact | 2529282382 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Waukesha Health System, Inc. 721 American Ave Suite 501 Waukesha WI 53188-5071 Ph: (262) 928-2396  | Waukesha Health System, Inc. 721 American Ave Suite 501 Waukesha WI 53188-5071 Ph: (262) 928-2396  | 
| NPI Number | 1346353695 | 
|---|---|
| Provider Enumeration Date | 08/17/2006 | 
| Last Update Date | 12/14/2022 | 
| Medicare PECOS PAC ID | 4082519517 | 
|---|---|
| Medicare Enrollment ID | O20040422001085 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1346353695 | NPI | - | NPPES | 
| 42125500 | Medicaid | WV | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261Q00000X | Clinic/center | 1976 (Wisconsin) | Primary | 
| Provider Name | Ryan Sershon | 
|---|---|
| Provider Type | Practitioner - Clinical Social Worker | 
| Provider Identifiers | NPI Number: 1407397938 PECOS PAC ID: 6103193701 Enrollment ID: I20170602001299  | 
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