Provider Demographics
| NPI: | 1154371847 |
|---|---|
| Name: | ADVANCED HEALTHCARE SC |
| Entity type: | Organization |
| Organization Name: | ADVANCED HEALTHCARE SC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | EUGENE |
| Authorized Official - Middle Name: | W |
| Authorized Official - Last Name: | MONROE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 414-352-3100 |
| Mailing Address - Street 1: | 3003 W GOOD HOPE RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MILWAUKEE |
| Mailing Address - State: | WI |
| Mailing Address - Zip Code: | 53209-2042 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 414-352-3100 |
| Mailing Address - Fax: | 414-247-4590 |
| Practice Address - Street 1: | 3003 W GOOD HOPE RD |
| Practice Address - Street 2: | |
| Practice Address - City: | MILWAUKEE |
| Practice Address - State: | WI |
| Practice Address - Zip Code: | 53209-2042 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 414-352-3100 |
| Practice Address - Fax: | 414-247-4590 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-11 |
| Last Update Date: | 2008-11-03 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WI | 41754200 | Medicaid | |
| WI | 32860900 | Medicaid | |
| WI | 32860900 | Medicaid | |
| WI | 0587990017 | Medicare NSC | |
| WI | 0587990010 | Medicare NSC | |
| WI | 0587990011 | Medicare NSC | |
| WI | 0587990008 | Medicare NSC | |
| WI | 0587990012 | Medicare NSC | |
| WI | 0587990006 | Medicare NSC | |
| WI | 0587990005 | Medicare NSC | |
| WI | 0587990007 | Medicare NSC | |
| WI | 68635 | Medicare ID - Type Unspecified | GROUP NUMBER |
| WI | 0587990021 | Medicare NSC | |
| WI | 0587990004 | Medicare NSC | |
| WI | 41754200 | Medicaid | |
| WI | 0587990001 | Medicare NSC | |
| WI | 0587990015 | Medicare NSC | |
| WI | 0587990016 | Medicare NSC | |
| WI | 0587990022 | Medicare NSC |
