Provider Demographics
NPI:1063780658
Name:LIFEVIEW CARE WISCONSIN S.C.
Entity type:Organization
Organization Name:LIFEVIEW CARE WISCONSIN S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-500-3337
Mailing Address - Street 1:901 S WHITNEY WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2553
Mailing Address - Country:US
Mailing Address - Phone:952-500-3337
Mailing Address - Fax:855-715-1907
Practice Address - Street 1:3600 AMERICAN BLVD W STE 225
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-4527
Practice Address - Country:US
Practice Address - Phone:952-500-3337
Practice Address - Fax:855-715-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1609853530OtherPROVIDER NPI