Provider Demographics
NPI:1336957711
Name:THRIVEMED, SC
Entity type:Organization
Organization Name:THRIVEMED, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:REIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:262-643-4900
Mailing Address - Street 1:11501 N PORT WASHINGTON RD STE G-30
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11501 N PORT WASHINGTON RD STE G-30
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3483
Practice Address - Country:US
Practice Address - Phone:262-643-4900
Practice Address - Fax:262-643-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No333600000XSuppliersPharmacy
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily