| Cmh Primary Care Clinic-mountain | |
|
14353 Hwy 32 & 64 Mountain WI 54149 | |
| (715) 276-1600 | |
| (715) 276-1800 |
| Full Name | Cmh Primary Care Clinic-mountain |
|---|---|
| Speciality | Family Medicine |
| Location | 14353 Hwy 32 & 64, Mountain, Wisconsin |
| Authorized Official Name and Position | Douglas C Gremban (PHYSICIAN DISPENSARY) |
| Authorized Official Contact | 7152761600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cmh Primary Care Clinic-mountain 14353 Hwy 32 & 64 Mountain WI 54149 Ph: (715) 276-1600 | Cmh Primary Care Clinic-mountain 14353 Hwy 32 & 64 Mountain WI 54149 Ph: (715) 276-1600 |
| NPI Number | 1962533455 |
|---|---|
| Provider Enumeration Date | 03/08/2007 |
| Last Update Date | 12/23/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962533455 | NPI | - | NPPES |
| 5128904 | Other | WI | NCPDP |
| 395585708005 | Other | WI | GREMBAN BC |
| 31756500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 23967-020 (Wisconsin) | Primary |
St Clare Memorial Hospital Mountain Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 14353 Hwy 32/64, Mountain, WI 54149 Phone: 715-276-1600 Fax: 715-276-1800 |