# ARCHWELL HEALTH PROFESSIONAL SERVICES OF WISCONSIN, SC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ArchWell Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164228797
- **Authorized official:** AMY MODDESETTE (SR. DIRECTOR, MANAGED CARE OPS)
- **Authorized official phone:** (913) 226-8221

## Contact information

- **Practice address:** 2730 N MARTIN LUTHER KING DR, MILWAUKEE, WI 53212-2312
- **Practice address phone:** (414) 508-0002
- **Mailing address:** 102 WOODMONT BLVD STE 600, NASHVILLE, TN 37205-5250
- **Mailing address phone:** (888) 987-1151

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/24/2025
- **Last updated:** 02/03/2026