| Northlakes Community Clinic | |
|
108 S Main St Birchwood WI 54817 | |
| (715) 354-3369 | |
| (715) 354-7158 |
| Full Name | Northlakes Community Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 108 S Main St, Birchwood, Wisconsin |
| Authorized Official Name and Position | Reba Rice (CEO) |
| Authorized Official Contact | 7153725001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northlakes Community Clinic 15954 Rivers Edge Dr Ste 304 Hayward WI 54843-7894 Ph: (715) 634-2541 | Northlakes Community Clinic 108 S Main St Birchwood WI 54817 Ph: (715) 354-3369 |
| NPI Number | 1750878542 |
|---|---|
| Provider Enumeration Date | 04/17/2018 |
| Last Update Date | 02/05/2019 |
| Medicare PECOS PAC ID | 0840366654 |
|---|---|
| Medicare Enrollment ID | O20220425000840 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750878542 | NPI | - | NPPES |
| 1811178825 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Birchwood Family Medicine, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 West Loomis Street, Suite A, Birchwood, WI 54817 Phone: 715-202-6782 Fax: 715-800-1982 |