Provider Demographics
NPI:1699747923
Name:WISCONSIN PATHOLOGISTS, S.C.
Entity type:Organization
Organization Name:WISCONSIN PATHOLOGISTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-267-6157
Mailing Address - Street 1:WPSC-SVA BILLING
Mailing Address - Street 2:P.O. BOX 44159
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53744
Mailing Address - Country:US
Mailing Address - Phone:608-826-2663
Mailing Address - Fax:
Practice Address - Street 1:36 S BROOKS ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1304
Practice Address - Country:US
Practice Address - Phone:608-267-6267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32702900Medicaid