IRIS HEALTH CLINIC (NPI# 1942735766) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942735766 |
| Entity Type | Organization |
| Organization Name | IRIS HEALTH CLINIC |
| Other Organization Name | IRIS HEALTH CLINIC |
| Practice Address |
403 N Grand Ave Waukesha WI 53186-4913 |
| Practice Telephone | 2624209088 |
| Practice Fax Number | 2624584102 |
| Mailing Telephone | 2624209088 |
| Mailing Fax Number | 2624584102 |
| Enumeration Date | 2017-04-30 |
| Last Update Date | 2018-12-03 |
| Authorized Official Name | PETER BRUNZELLE (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9713343150 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 207QA0401X |
Family Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities | ||
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| N | 291U00000X | Clinical Medical Laboratory | Laboratories | ||
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Iris Health Clinic | Doing Business As Name - Organization |
| Street Address |
403 N GRAND AVE |
| City | WAUKESHA |
| State | WI |
| Zip Code | 53186-4913 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851300933 | Glenn Toth | Family Medicine | 403 N Grand Ave, Waukesha, WI 53186-4913 | 2006-08-06 |
| 1518500776 | Paige Foss | Counselor | 403 N Grand Ave, Waukesha, WI 53186-4984 | 2019-10-21 |
| 1700341542 | Joshua Brunia | Massage Therapist | 403 N Grand Ave, Waukesha, WI 53186-4984 | 2019-02-06 |
| 1447726575 | Richelle Mastalir | Counselor | 403 N Grand Ave, Waukesha, WI 53186-4913 | 2018-10-16 |
| 1588147573 | Chanita Jedlicka | Massage Therapist | 403 N Grand Ave, Waukesha, WI 53186-4913 | 2018-09-14 |
| 1932695871 | Iris Health Clinic LLC | Internal Medicine | 403 N Grand Ave, Waukesha, WI 53186-4913 | 2018-07-03 |
| 1033611850 | Waukesha Community Acupuncture & Massage | Massage Therapist | 403 N Grand Ave, Waukesha, WI 53186-4913 | 2018-03-07 |
| 1811351331 | Blia Vang | Counselor | 403 N Grand Ave, Waukesha, WI 53186-4984 | 2016-04-11 |
| 1295980019 | Waukesha Environmental Health | Allergy & Immunology | 403 N Grand Ave, Waukesha, WI 53186-4913 | 2008-11-20 |
| 1285800367 | Wayne Harry Konetzki | Internal Medicine | 403 N Grand Ave, Waukesha, WI 53186-4913 | 2008-05-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295391472 | Christine Lowdon Triggs | Dentist | 21680 West Bluemound Rd, Waukesha, WI 53186 | 2019-05-14 |
| 1881182889 | Allure Medical of Wisconsin Pllc | Clinic/Center | 1930 W Bluemound Rd Ste 340, Waukesha, WI 53186 | 2018-04-25 |
| 1316462104 | Mary B Mckee | Dietitian, Registered | 22370 W Bluemound Rd, #102, Waukesha, WI 53186 | 2017-08-14 |
| 1740738343 | Rebecca Menelle | Physical Therapist | 1809 Shepherd Ct, Apt 206, Waukesha, WI 53186 | 2016-09-13 |
| 1568919876 | Dianne Isnard | Physical Therapist | W231n1440 Corporate Court, Waukesha, WI 53186 | 2016-09-02 |
| 1982065991 | Brandon James Decker | Nurse Practitioner | 21775 Hillcrest Drive, Waukesha, WI 53186 | 2016-03-18 |
| 1598142937 | Sophia Marie Klingbiel | Social Worker | 1515 Paramount Dr., Waukesha, WI 53186 | 2015-05-06 |
| 1326478165 | Glen D Haberman | Dentist | 141 Wisconsin Avenue, Waukesha, WI 53186 | 2013-11-14 |
| 1487991014 | Sara Nicole Francis | Counselor | 217 Wisconsin Ave Ste 211, Waukesha, WI 53186 | 2013-01-16 |
| 1770862054 | Alex Colque, M.d. S.c. | Plastic Surgery | 21675 E Moreland Blvd, Suite 100, Waukesha, WI 53186 | 2011-08-04 |
| Find all providers in zip 53186 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
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| 1215579552 | Integrated Treatment Centers, LLC | Clinic/Center | 2311 W Mason Street, Green Bay, WI 54303 | 2019-10-08 |
| 1952860181 | Symetria Health of Wisconsin, L.L.C. | Clinic/Center | 6080 S 108th St Ste B, Hales Corners, WI 53130-2557 | 2019-03-18 |
| 1184182602 | Symetria Health of Wisconsin, L.L.C. | Clinic/Center | 2997 Yarmouth Greenway Dr Ste 100, Fitchburg, WI 53711-5809 | 2019-03-04 |
| 1912464934 | The Ladders Recovery Community | Clinic/Center | 1331 Capitol Dr, Oconomowoc, WI 53066-5705 | 2019-02-26 |
| 1093215410 | Ray Services LLC | Clinic/Center | 147 W Ryan Rd, Oak Creek, WI 53154-4401 | 2018-02-13 |
| 1518498047 | Treatment Providers LLC | Clinic/Center | 2731 N Packerland Dr Ste A, Green Bay, WI 54303 | 2017-03-26 |
| 1245628817 | Forever Free Substance Abuse and Mental Heath Treament Center | Clinic/Center | 724 S Layton Blvd, Milwaukee, WI 53215-1224 | 2015-01-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.