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2600 65th Ave Osceola WI 54020-4370 | |
(715) 294-2111 | |
(715) 294-5758 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2600 65th Ave, Osceola, Wisconsin |
Authorized Official Name and Position | Matt Forge (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 7152945622 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 218 Osceola WI 54020-0218 Ph: (715) 294-2111 | 2600 65th Ave Osceola WI 54020-4370 Ph: (715) 294-2111 |
NPI Number | 1801394549 |
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Provider Enumeration Date | 01/29/2018 |
Last Update Date | 01/10/2020 |
Medicare PECOS PAC ID | 9931092848 |
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Medicare Enrollment ID | O20180309000995 |
Identifier | Type | State | Issuer |
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1801394549 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 1021 (Wisconsin) | Primary |