Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 110 E 5th Ave, Antigo, 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 | 110 E 5th Ave Antigo WI 54409-2710 Ph: (715) 623-2351 |
NPI Number | 1821151366 |
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Provider Enumeration Date | 12/18/2006 |
Last Update Date | 06/13/2024 |
Medicare PECOS PAC ID | 1557271202 |
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Medicare Enrollment ID | O20170510002395 |
Identifier | Type | State | Issuer |
---|---|---|---|
1821151366 | NPI | - | NPPES |
Antigo Medical Building, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1111 Langlade Rd, Antigo, WI 54409 Phone: 715-623-3761 Fax: 715-623-3764 | |