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1225 Langlade Rd Antigo WI 54409-2762 | |
(715) 623-2394 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 1225 Langlade Rd, Antigo, Wisconsin |
Authorized Official Name and Position | Michael Loy (INTERIM CEO) |
Authorized Official Contact | 7158484600 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1100 Lake View Dr Wausau WI 54403-6785 Ph: (715) 848-4600 | 1225 Langlade Rd Antigo WI 54409-2762 Ph: (715) 623-2394 |
NPI Number | 1134234206 |
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Provider Enumeration Date | 08/20/2006 |
Last Update Date | 08/01/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134234206 | NPI | - | NPPES |
42170800 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | 1676 (Wisconsin) | Primary |
Antigo Medical Building, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1111 Langlade Rd, Antigo, WI 54409 Phone: 715-623-3761 Fax: 715-623-3764 | |