| Behavioral Medicine Center | |
|
721 American Ave Suite 501 Waukesha WI 53188-5071 | |
| (262) 928-2396 | |
| (262) 544-1213 |
| Full Name | Behavioral Medicine Center |
|---|---|
| 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 |
|---|---|
| Behavioral Medicine Center 721 American Ave Suite 501 Waukesha WI 53188-5071 Ph: (262) 928-2396 | Behavioral Medicine Center 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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