Organization
PAIN CENTERS OF WISCONSIN - FORT ATKINSON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN BARTELL (DIRECTOR/PRIVACY OFFICER)
(920) 568-6558
Entity
Organization
Contact information
Practice address
1604 MADISON AVE, FORT ATKINSON, WI 53538-3101
(920) 568-6596
(920) 568-9429
Mailing address
PO BOX 660, FORT ATKINSON, WI 53538-0660
(920) 568-9429
(920) 568-9429
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100176317
—
WI
Enumeration date
01/25/2012
Last updated
10/07/2022
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