Pai Participant 23 Sc | |
1475 Birch Hill Ln Shawano WI 54166-3707 | |
(715) 526-3161 | |
Not Available |
Full Name | Pai Participant 23 Sc |
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Speciality | Internal Medicine |
Location | 1475 Birch Hill Ln, Shawano, Wisconsin |
Authorized Official Name and Position | Erin Laird (AUTHORIZED OFFICIAL) |
Authorized Official Contact | 4104588713 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Pai Participant 23 Sc Po Box 639676 Cincinnati OH 45263-9676 Ph: (859) 291-4800 | Pai Participant 23 Sc 1475 Birch Hill Ln Shawano WI 54166-3707 Ph: (715) 526-3161 |
NPI Number | 1528674801 |
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Provider Enumeration Date | 09/22/2020 |
Last Update Date | 09/22/2020 |
Medicare PECOS PAC ID | 5799104972 |
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Medicare Enrollment ID | O20201008000177 |
Identifier | Type | State | Issuer |
---|---|---|---|
1528674801 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
Shawano County Health Department Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 311 N Main St Rm 7, Shawano, WI 54166 Phone: 715-526-4808 Fax: 715-524-5792 | |
Thedacare Physicians Shawano Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 117 E Green Bay St, Shawano, WI 54166 Phone: 920-996-3298 | |
Thedacare Medical Center - Shawano, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 100 County Road B, Shawano, WI 54166 Phone: 715-524-2161 Fax: 715-524-8164 |