| Glmc East Building | |
|
724 Denton St La Crosse WI 54601-5447 | |
| (608) 782-7300 | |
| Not Available |
| Full Name | Glmc East Building |
|---|---|
| Speciality | Clinic/Center |
| Location | 724 Denton St, La Crosse, Wisconsin |
| Authorized Official Name and Position | Kari B Adank (CCO) |
| Authorized Official Contact | 6087758025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glmc East Building 1910 South Ave La Crosse WI 54601-5467 Ph: (608) 782-7300 | Glmc East Building 724 Denton St La Crosse WI 54601-5447 Ph: (608) 782-7300 |
| NPI Number | 1497090138 |
|---|---|
| Provider Enumeration Date | 12/06/2012 |
| Last Update Date | 03/25/2022 |
| Medicare PECOS PAC ID | 2163331414 |
|---|---|
| Medicare Enrollment ID | O20130812000865 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497090138 | NPI | - | NPPES |
| 765347600 | Medicaid | MN | |
| 11012900 | Medicaid | WI | |
| 100020154 | Medicaid | WI | |
| 42194300 | Medicaid | WI | |
| 0699017 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
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