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206 North Mill Street La Farge WI 54639-6601 | |
(608) 625-2494 | |
(608) 638-5011 |
Full Name | |
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Speciality | Clinic/Center |
Location | 206 North Mill Street, La Farge, 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 |
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206 North Mill Street La Farge WI 54639-6601 Ph: (608) 625-2494 | 206 North Mill Street La Farge WI 54639-6601 Ph: (608) 625-2494 |
NPI Number | 1750387221 |
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Provider Enumeration Date | 06/21/2005 |
Last Update Date | 01/09/2020 |
Medicare PECOS PAC ID | 8325958416 |
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Medicare Enrollment ID | O20030618000016 |
Identifier | Type | State | Issuer |
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1750387221 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |