| |
610 W Adams St Black River Falls WI 54615-9110 | |
(715) 284-4311 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 610 W Adams St, Black River Falls, Wisconsin |
Authorized Official Name and Position | Holly M Winn (CFO) |
Authorized Official Contact | 7152841354 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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711 W Adams St Black River Falls WI 54615-5052 Ph: (715) 284-5361 | 610 W Adams St Black River Falls WI 54615-9110 Ph: (715) 284-4311 |
NPI Number | 1568196764 |
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Provider Enumeration Date | 07/13/2022 |
Last Update Date | 01/06/2025 |
Medicare PECOS PAC ID | 3173431178 |
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Medicare Enrollment ID | O20220811003355 |
Identifier | Type | State | Issuer |
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1568196764 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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