| Lakeshore Community Health Care, Inc | |
|
2719 Calumet Ave Manitowoc WI 54220-5546 | |
| (920) 686-2333 | |
| (920) 686-2334 |
| Full Name | Lakeshore Community Health Care, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2719 Calumet Ave, Manitowoc, Wisconsin |
| Authorized Official Name and Position | David Hughes (CFO) |
| Authorized Official Contact | 9207836633 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeshore Community Health Care, Inc Po Box 959 Sheboygan WI 53082-0959 Ph: (920) 783-6633 | Lakeshore Community Health Care, Inc 2719 Calumet Ave Manitowoc WI 54220-5546 Ph: (920) 686-2333 |
| NPI Number | 1508391020 |
|---|---|
| Provider Enumeration Date | 04/21/2017 |
| Last Update Date | 04/21/2017 |
| Medicare PECOS PAC ID | 3173773124 |
|---|---|
| Medicare Enrollment ID | O20170905001862 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508391020 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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Mark L Herring M.d., S.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1355 Johnston Dr, Manitowoc, WI 54220 Phone: 920-682-2747 Fax: 920-686-1498 | |
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Lakeshore Community Health Care, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 601 Buffalo St, Manitowoc, WI 54220 Phone: 920-686-2333 Fax: 920-783-6392 | |
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