Provider Demographics
NPI:1124804026
Name:WISCONSIN CENTER FOR INFUSION, SC
Entity type:Organization
Organization Name:WISCONSIN CENTER FOR INFUSION, SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:RAASCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-239-6248
Mailing Address - Street 1:10750 W HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1321
Mailing Address - Country:US
Mailing Address - Phone:414-460-3195
Mailing Address - Fax:
Practice Address - Street 1:3870 S 108TH ST STE B
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1308
Practice Address - Country:US
Practice Address - Phone:414-460-3195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-06
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty