Provider Demographics
NPI:1174126254
Name:JIR PSYCHIATRY
Entity type:Organization
Organization Name:JIR PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-793-4277
Mailing Address - Street 1:13500 WATERTOWN PLANK RD
Mailing Address - Street 2:#102
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2222
Mailing Address - Country:US
Mailing Address - Phone:262-794-3076
Mailing Address - Fax:949-655-2632
Practice Address - Street 1:13500 WATERTOWN PLANK RD
Practice Address - Street 2:#102
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2222
Practice Address - Country:US
Practice Address - Phone:262-794-3076
Practice Address - Fax:949-655-2632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)