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WISCONSIN SPINE AND PAIN SC
NPI 1154149367
Durable Medical Equipment & Medical Supplies in West Bend, WI

Active since September 27, 2024CLIA Certified · 2 labs
1000 GATEWAY COURT SUITE 100, WEST BEND, WI 53095(920) 204-6758 Get Directions Write a Review

NPPES record last updated: September 27, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Wisconsin Spine And Pain Sc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WISCONSIN SPINE AND PAIN SC (NPI 1154149367) is a healthcare organization registered as a durable medical equipment & medical supplies in West Bend, Wisconsin and active in the NPI registry since September 2024. The organization holds 2 active CLIA laboratory certificates and lists Michael Jung, Md, as its authorized official.

NPPES Registry Identity

NPI1154149367
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameWISCONSIN SPINE AND PAIN SC
Location Address1000 GATEWAY COURT SUITE 100West Bend, WI 53095-8541
Mailing AddressDept. Ch 17057Palatine, IL 60055-7057 · (920) 204-6758
Phone(920) 204-6758
Organization SubpartNo
Authorized OfficialMichael JungMd · (414) 455-1153
Enumeration DateSeptember 27, 2024
NPPES CertifiedSeptember 27, 2024
✔ NPI 1154149367 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers
Taxonomy Code332B00000X
Definition
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
1000 GATEWAY COURT SUITE 100, West Bend, WI 53095
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CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D2207660

Wisconsin Spine And Pain Sc · West Bend, WI
Active · expires Dec 29, 2026
CLIA Number52D2207660
Laboratory TypePhysician Office
Certificate Effective DateDecember 30, 2024
Certificate Expiration DateDecember 29, 2026
Laboratory DirectorDr. Michael Jung
Laboratory Phone(920) 838-6426
Laboratory LocationWisconsin Spine And Pain Sc1000 Gateway Court Suite 100, West Bend, WI 53095
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 52D2204989

Wisconsin Spine And Pain, Sc · Sheboygan, WI
Active · expires Mar 15, 2028
CLIA Number52D2204989
Laboratory TypePhysician Office
Certificate Effective DateMarch 16, 2026
Certificate Expiration DateMarch 15, 2028
Laboratory DirectorDr. Jeremy Scarlett
Laboratory Phone(920) 204-6758
Laboratory LocationWisconsin Spine And Pain, Sc2124 Kohler Memorial Drive, Suite 100, Sheboygan, WI 53081
CLIA data matches this NPI record on: Name Phone
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wisconsin Spine And Pain Sc's NPI number?

The NPI number for Wisconsin Spine And Pain Sc is 1154149367. It was assigned to this organization in the NPPES registry on September 27, 2024.

Where is Wisconsin Spine And Pain Sc located?

Wisconsin Spine And Pain Sc is located at 1000 Gateway Court Suite 100, West Bend, WI 53095. The listed phone number is (920) 204-6758.

What is Wisconsin Spine And Pain Sc's specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

Does Wisconsin Spine And Pain Sc hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Wisconsin Spine And Pain Sc was last updated on September 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.