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1180 Chandler Drive Spooner WI 54801 | |
(715) 635-2151 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1180 Chandler Drive, Spooner, Wisconsin |
Authorized Official Name and Position | Kevin Boren (VP OF FINANCE) |
Authorized Official Contact | 2187861009 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1180 Chandler Drive Spooner WI 54801 Ph: (715) 635-2151 | 1180 Chandler Drive Spooner WI 54801 Ph: (715) 635-2151 |
NPI Number | 1083161301 |
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Provider Enumeration Date | 09/02/2016 |
Last Update Date | 02/28/2024 |
Medicare PECOS PAC ID | 8628964228 |
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Medicare Enrollment ID | O20170314000067 |
Identifier | Type | State | Issuer |
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1083161301 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Evergreen Holistic Healing Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 415 N Front St, Spooner, WI 54801 Phone: 715-544-8964 | |