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1660 Sue Alan Dr Wittenberg WI 54499-8655 | |
(715) 253-2110 | |
(715) 253-3028 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1660 Sue Alan Dr, Wittenberg, Wisconsin |
Authorized Official Name and Position | Jerry M Yang (SVP & CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 7158472526 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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29980 Network Pl Chicago IL 60673-1299 Ph: (715) 847-2304 | 1660 Sue Alan Dr Wittenberg WI 54499-8655 Ph: (715) 253-2110 |
NPI Number | 1114696507 |
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Provider Enumeration Date | 09/08/2021 |
Last Update Date | 06/07/2024 |
Medicare PECOS PAC ID | 9335059856 |
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Medicare Enrollment ID | O20220105001278 |
Identifier | Type | State | Issuer |
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1114696507 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |