| |
403 Stageline Road Hudson WI 54016 | |
(715) 531-6800 | |
(715) 531-6801 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 403 Stageline Road, Hudson, Wisconsin |
Authorized Official Name and Position | Ernie Wallin (ADMINISTRATOR DIRECTOR) |
Authorized Official Contact | 7155316800 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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403 Stageline Road Hudson WI 54016 Ph: (715) 531-6800 | 403 Stageline Road Hudson WI 54016 Ph: (715) 531-6800 |
NPI Number | 1679534697 |
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Provider Enumeration Date | 03/29/2006 |
Last Update Date | 10/13/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1679534697 | NPI | - | NPPES |
32723100 | Medicaid | WI | |
56125 | Other | WI | MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (Wisconsin) | Primary |
291U00000X | Clinical Medical Laboratory | (Wisconsin) | Secondary |
Promed Preferred Wi Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 155 2nd St S, Hudson, WI 54016 Phone: 615-499-3165 | |
Fairview Express Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2651 Hillcrest Dr Ste 302, Hudson, WI 54016 Phone: 612-365-5000 | |
Hudson Physicians S.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 403 Stageline Rd, Hudson, WI 54016 Phone: 715-531-6800 Fax: 715-531-6801 |