Chn Medical Center Eastridge | |
W832 State Road 91 Ste 3 Berlin WI 54923-8821 | |
(920) 361-6400 | |
(920) 361-6407 |
Full Name | Chn Medical Center Eastridge |
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Speciality | Family Medicine |
Location | W832 State Road 91, Berlin, Wisconsin |
Authorized Official Name and Position | Steven Ruedinger (VICE PRESIDENT) |
Authorized Official Contact | 9203615988 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Chn Medical Center Eastridge W832 State Road 91 Ste 3 Berlin WI 54923-8821 Ph: (920) 361-6400 | Chn Medical Center Eastridge W832 State Road 91 Ste 3 Berlin WI 54923-8821 Ph: (920) 361-6400 |
NPI Number | 1134428105 |
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Provider Enumeration Date | 03/16/2011 |
Last Update Date | 07/07/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134428105 | NPI | - | NPPES |
11011000 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 45822 (Wisconsin) | Primary |