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2817 New Pinery Rd Portage WI 53901-9240 | |
(608) 745-4131 | |
(608) 742-6098 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2817 New Pinery Rd, Portage, Wisconsin |
Authorized Official Name and Position | Jerry M Yang (SVP & CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 7158472526 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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29980 Network Pl Chicago IL 60673-1299 Ph: (715) 847-2304 | 2817 New Pinery Rd Portage WI 53901-9240 Ph: (608) 745-4131 |
NPI Number | 1386154417 |
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Provider Enumeration Date | 10/03/2017 |
Last Update Date | 06/14/2024 |
Medicare PECOS PAC ID | 5799684007 |
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Medicare Enrollment ID | O20171227002588 |
Identifier | Type | State | Issuer |
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1386154417 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (Wisconsin) | Primary |