Full Name | |
---|---|
Speciality | Clinic/center |
Location | 1420 Algoma St, New London, 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 |
---|---|
1420 Algoma St New London WI 54961-2104 Ph: (920) 738-2000 | 1420 Algoma St New London WI 54961 Ph: (920) 982-8300 |
NPI Number | 1093982530 |
---|---|
Provider Enumeration Date | 05/14/2008 |
Last Update Date | 03/27/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1093982530 | NPI | - | NPPES |
32752000 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Brian Van Hoozen Do Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1505 Mill St, New London, WI 54961 Phone: 920-982-7900 Fax: 920-982-7995 |