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2215 Progress Blvd Antigo WI 54409-2480 | |
(715) 623-2351 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 2215 Progress Blvd, Antigo, Wisconsin |
Authorized Official Name and Position | Jerry M Yang (SVP & CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 7158472526 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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29980 Network Pl Chicago IL 60673-1299 Ph: (715) 847-2304 | 2215 Progress Blvd Antigo WI 54409-2480 Ph: (715) 623-2351 |
NPI Number | 1255413274 |
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Provider Enumeration Date | 10/19/2006 |
Last Update Date | 06/14/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255413274 | NPI | - | NPPES |
41674100 | Medicaid | WI | |
32850800 | Medicaid | WI | |
0212750002 | Other | WI | DMEPOS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (Wisconsin) | 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 | |