| Lafayette County | |
|
104 S Judgement St Shullsburg WI 53586-9549 | |
| (608) 965-4475 | |
| Not Available |
| Full Name | Lafayette County |
|---|---|
| Speciality | Clinic/Center |
| Location | 104 S Judgement St, Shullsburg, Wisconsin |
| Authorized Official Name and Position | Kathy Margaret Kuepers (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6087764466 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lafayette County 800 Clay St Darlington WI 53530-1228 Ph: (608) 776-4466 | Lafayette County 104 S Judgement St Shullsburg WI 53586-9549 Ph: (608) 965-4475 |
| NPI Number | 1285150045 |
|---|---|
| Provider Enumeration Date | 08/14/2017 |
| Last Update Date | 09/28/2022 |
| Medicare PECOS PAC ID | 9436054772 |
|---|---|
| Medicare Enrollment ID | O20170921000720 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285150045 | NPI | - | NPPES |
| 521312 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
The Shullsburg Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 104 S Judgement St, Shullsburg, WI 53586 Phone: 608-965-4475 Fax: 608-965-3186 |