| Ch Specialty Services Wi Sc | |
|
1366 E Sumner St # 1002 Hartford WI 53027-1614 | |
| (337) 991-9276 | |
| Not Available |
| Full Name | Ch Specialty Services Wi Sc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1366 E Sumner St # 1002, Hartford, Wisconsin |
| Authorized Official Name and Position | Nicole Howard (SR VP OF ADMINISTRATIVE SERVICES) |
| Authorized Official Contact | 3379919276 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ch Specialty Services Wi Sc 1509 Dulles Dr Lafayette LA 70506-3718 Ph: (337) 991-9276 | Ch Specialty Services Wi Sc 1366 E Sumner St # 1002 Hartford WI 53027-1614 Ph: (337) 991-9276 |
| NPI Number | 1063115319 |
|---|---|
| Provider Enumeration Date | 03/24/2023 |
| Last Update Date | 03/24/2023 |
| Medicare PECOS PAC ID | 9234504820 |
|---|---|
| Medicare Enrollment ID | O20230413000664 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063115319 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Priya Asija |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982817771 PECOS PAC ID: 8729188461 Enrollment ID: I20070711000355 |
| Provider Name | Debbra L Spexet |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366460677 PECOS PAC ID: 7214956374 Enrollment ID: I20110302000104 |
| Provider Name | Jessica A Ryan-geiger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811409485 PECOS PAC ID: 5193086643 Enrollment ID: I20180227000314 |
| Provider Name | Hallie Richards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063065274 PECOS PAC ID: 6002299971 Enrollment ID: I20220810003297 |
| Provider Name | Antonio Gamboa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154356780 PECOS PAC ID: 2264468222 Enrollment ID: I20230224002109 |
| Provider Name | Brian Cooper |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366678963 PECOS PAC ID: 0547426223 Enrollment ID: I20230405002210 |
| Provider Name | Brian Whyms |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1821440066 PECOS PAC ID: 2365736378 Enrollment ID: I20230501002651 |
| Provider Name | Tasha Janssen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447808233 PECOS PAC ID: 1850621145 Enrollment ID: I20230728001012 |
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