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600 W Shell Creek Rd Minong WI 54859-9302 | |
(715) 466-2201 | |
(715) 466-2205 |
Full Name | |
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Speciality | Clinic/Center |
Location | 600 W Shell Creek Rd, Minong, 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 |
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15735 W Us Highway 63 Hayward WI 54843-6475 Ph: (715) 934-0710 | 600 W Shell Creek Rd Minong WI 54859-9302 Ph: (715) 466-2201 |
NPI Number | 1083961163 |
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Provider Enumeration Date | 08/08/2012 |
Last Update Date | 08/05/2021 |
Medicare PECOS PAC ID | 7810940244 |
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Medicare Enrollment ID | O20111024000447 |
Identifier | Type | State | Issuer |
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1083961163 | NPI | - | NPPES |
1811178825 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 26972 (Wisconsin) | Primary |