| |
1615 Maple Ln Ashland WI 54806-3610 | |
(715) 685-5500 | |
(715) 685-5118 |
Full Name | |
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Speciality | Psychiatric Unit |
Location | 1615 Maple Ln, Ashland, Wisconsin |
Authorized Official Name and Position | Jason T Douglas (PRESIDENT) |
Authorized Official Contact | 7156855512 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1615 Maple Ln Ashland WI 54806-3610 Ph: (715) 685-5500 | 1615 Maple Ln Ashland WI 54806-3610 Ph: (715) 685-5500 |
NPI Number | 1801005210 |
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Provider Enumeration Date | 05/22/2007 |
Last Update Date | 11/22/2023 |
Certification Date | 11/22/2023 |
Medicare PECOS PAC ID | 8022000447 |
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Medicare Enrollment ID | O20070706000128 |
Identifier | Type | State | Issuer |
---|---|---|---|
1801005210 | NPI | - | NPPES |
11019526 | Medicaid | WI | |
0160HME | Other | MN | BLUE CROSS BLUE SHIELD |
3901638 | Other | WI | MEDICA PROF COMPONENT |
11019500 | Medicaid | WI | |
01022385 | Other | WI | PREFERRED ONE |
0160JME | Other | MN | BLUE CROSS BLUE SHIELD |
11019521 | Medicaid | WI | |
36585ME | Other | MN | BCBS PROF COMPONENT |
5025472 | Other | WI | MEDICA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
273R00000X | Psychiatric Unit | 275 (Wisconsin) | Primary |
Provider Name | Michael C Murphy |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972694701 PECOS PAC ID: 9830281336 Enrollment ID: I20070828000519 |
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