Full Name | |
---|---|
Speciality | Family Medicine |
Location | 420 W North St, Juneau, Wisconsin |
Authorized Official Name and Position | Gordon T Edwards (CFO/COO/AO) |
Authorized Official Contact | 7153875823 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1000 N Oak Ave Attn: Provider Enrollment Services/wwp Marshfield WI 54449-5703 Ph: (715) 389-0660 | 420 W North St Juneau WI 53039 Ph: (920) 386-8101 |
NPI Number | 1831410521 |
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Provider Enumeration Date | 06/16/2010 |
Last Update Date | 03/03/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831410521 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |