| |
1100 Lake View Dr Wausau WI 54403-6785 | |
(715) 848-4600 | |
(715) 845-5398 |
Full Name | |
---|---|
Speciality | Clinic/center - Multi-specialty |
Location | 1100 Lake View Dr, Wausau, 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 |
---|---|
1100 Lake View Dr Wausau WI 54403-6785 Ph: (715) 848-4600 | 1100 Lake View Dr Wausau WI 54403-6785 Ph: (715) 848-4600 |
NPI Number | 1194833434 |
---|---|
Provider Enumeration Date | 08/28/2006 |
Last Update Date | 08/01/2017 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194833434 | NPI | - | NPPES |
43105800 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | 1677 (Wisconsin) | Primary |
Spine & Brain Group Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2800 Westhill Dr, Suite 200, Wausau, WI 54401 Phone: 715-843-1000 Fax: 715-843-1001 |