Full Name | |
---|---|
Speciality | Clinic/center - Multi-specialty |
Location | 618 Memorial Dr, Chilton, Wisconsin |
Authorized Official Name and Position | J. Bryan Fissel (VP-FINANCE) |
Authorized Official Contact | 4144653000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
618 Memorial Dr Chilton WI 53014-1568 Ph: (920) 738-2000 | 618 Memorial Dr Chilton WI 53014 Ph: (920) 849-3800 |
NPI Number | 1588831739 |
---|---|
Provider Enumeration Date | 05/15/2008 |
Last Update Date | 03/27/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1588831739 | NPI | - | NPPES |
32752000 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |