Organization
FROEDTERT SOUTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS J KELLEY III (VP & CFO)
(262) 577-8113
Entity
Organization
Contact information
Practice address
9555 76TH ST, PLEASANT PRAIRIE, WI 53158-1984
(262) 577-8000
(262) 653-5852
Mailing address
6308 8TH AVE, KENOSHA, WI 53143-5031
(262) 656-2011
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
52-2335
WI
282N00000X
General Acute Care Hospital
Primary
52-0021
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11007800
—
WI
Enumeration date
07/12/2006
Last updated
09/22/2022
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