| Jackson Clinic | |
|
W225n16711 Cedar Park Ct Jackson WI 53037-9222 | |
| (262) 677-1101 | |
| Not Available |
| Full Name | Jackson Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | W225n16711 Cedar Park Ct, Jackson, Wisconsin |
| Authorized Official Name and Position | Gregory G Blommel (MEDICAL DIRECTOR) |
| Authorized Official Contact | 2623343451 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jackson Clinic 1700 W Paradise Dr West Bend WI 53095-9795 Ph: (262) 334-3451 | Jackson Clinic W225n16711 Cedar Park Ct Jackson WI 53037-9222 Ph: (262) 677-1101 |
| NPI Number | 1275542607 |
|---|---|
| Provider Enumeration Date | 08/05/2006 |
| Last Update Date | 05/23/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275542607 | NPI | - | NPPES |
| 21251400 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
Aurora Medical Group, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: N168w20060 Main St, Jackson, WI 53037 Phone: 262-677-3661 |