| Bouc Family Wellness Center, Llc | |
|
3005 Riverside Dr Suite 101 Beloit WI 53511-1500 | |
| (608) 365-7200 | |
| (608) 365-7202 |
| Full Name | Bouc Family Wellness Center, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3005 Riverside Dr, Beloit, Wisconsin |
| Authorized Official Name and Position | Geoffrey T Bouc (PHYSICIAN) |
| Authorized Official Contact | 6083657200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bouc Family Wellness Center, Llc 3005 Riverside Dr Suite 101 Beloit WI 53511-1500 Ph: (608) 365-7200 | Bouc Family Wellness Center, Llc 3005 Riverside Dr Suite 101 Beloit WI 53511-1500 Ph: (608) 365-7200 |
| NPI Number | 1356520563 |
|---|---|
| Provider Enumeration Date | 10/24/2007 |
| Last Update Date | 04/26/2018 |
| Medicare PECOS PAC ID | 9032170857 |
|---|---|
| Medicare Enrollment ID | O20041025000374 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356520563 | NPI | - | NPPES |
| 32161500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 36893 (Wisconsin) | Primary |
| Provider Name | Geoffrey T Bouc |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609947159 PECOS PAC ID: 5991766727 Enrollment ID: I20041025000440 |
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