Provider Demographics
NPI:1215175146
Name:VIVENT HEALTH INC
Entity type:Organization
Organization Name:VIVENT HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR OF CORPORATE SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BERK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-225-1568
Mailing Address - Street 1:820 N PLANKINTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-1802
Mailing Address - Country:US
Mailing Address - Phone:414-225-1542
Mailing Address - Fax:414-225-1575
Practice Address - Street 1:1311 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-4006
Practice Address - Country:US
Practice Address - Phone:866-525-5484
Practice Address - Fax:414-225-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38390700Medicaid