| |
102 Sunset Ave Soldiers Grove WI 54655-1400 | |
(608) 624-5203 | |
(608) 624-5572 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 102 Sunset Ave, Soldiers Grove, Wisconsin |
Authorized Official Name and Position | David Hartberg (CEO) |
Authorized Official Contact | 6086374796 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
507 S Main St Viroqua WI 54665-2059 Ph: (608) 624-5203 | 102 Sunset Ave Soldiers Grove WI 54655-1400 Ph: (608) 624-5203 |
NPI Number | 1376549824 |
---|---|
Provider Enumeration Date | 06/21/2005 |
Last Update Date | 01/07/2020 |
Medicare PECOS PAC ID | 8325958416 |
---|---|
Medicare Enrollment ID | O20100602000502 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376549824 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |