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310 West Main Street Sparta WI 54656 | |
(608) 269-1770 | |
(608) 269-1017 |
Full Name | |
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Speciality | Clinic/Center |
Location | 310 West Main Street, Sparta, Wisconsin |
Authorized Official Name and Position | Mark Bortnem (CHIEF FINANICIAL OFFICER) |
Authorized Official Contact | 7158385270 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 860056 Attn: Revenue Recognition & Compliance Minneapolis MN 55486-0056 Ph: (608) 791-4156 | 310 West Main Street Sparta WI 54656 Ph: (608) 269-1770 |
NPI Number | 1366420788 |
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Provider Enumeration Date | 01/05/2006 |
Last Update Date | 01/09/2024 |
Medicare PECOS PAC ID | 0345152443 |
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Medicare Enrollment ID | O20110125000911 |
Identifier | Type | State | Issuer |
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1366420788 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Scenic Bluffs Health Center, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 201 E Franklin St # B3, Sparta, WI 54656 Phone: 608-654-5100 | |