| |
2400 Marshall St Ste A Wausau WI 54403-6738 | |
(715) 848-4600 | |
(715) 845-5398 |
Full Name | |
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Speciality | Clinic/center - Multi-specialty |
Location | 2400 Marshall St Ste A, Wausau, Wisconsin |
Authorized Official Name and Position | Gary D. Olsen (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 7158484600 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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2400 Marshall St Ste A Wausau WI 54403-6738 Ph: (715) 848-4600 | 2400 Marshall St Ste A Wausau WI 54403-6738 Ph: (715) 848-4600 |
NPI Number | 1477661718 |
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Provider Enumeration Date | 08/28/2006 |
Last Update Date | 10/19/2023 |
Identifier | Type | State | Issuer |
---|---|---|---|
1477661718 | NPI | - | NPPES |
40414700 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | 206 (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 |