Full Name | |
---|---|
Speciality | Clinic/center |
Location | 501 Aurora St, Antigo, Wisconsin |
Authorized Official Name and Position | Forrest Dean Danner (VP/COO) |
Authorized Official Contact | 7158472975 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 8040 Wisconsin Rapids WI 54495-8040 Ph: (715) 423-0122 | 501 Aurora St Antigo WI 54409-2721 Ph: (715) 623-2351 |
NPI Number | 1962711556 |
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Provider Enumeration Date | 09/29/2010 |
Last Update Date | 09/29/2010 |
Identifier | Type | State | Issuer |
---|---|---|---|
1962711556 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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 | |