Full Name | |
---|---|
Speciality | Family Medicine |
Location | 825 Main St, Plain, Wisconsin |
Authorized Official Name and Position | James Dregney (CFO) |
Authorized Official Contact | 6086437212 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
825 Main St Plain WI 53577-9668 Ph: (608) 546-4211 | 825 Main St Plain WI 53577-9668 Ph: (608) 546-4211 |
NPI Number | 1134194004 |
---|---|
Provider Enumeration Date | 02/22/2006 |
Last Update Date | 02/22/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134194004 | NPI | - | NPPES |
43062000 | Medicaid | WI | |
CD3549 | Other | RAILROAD MEDICARE | |
32764200 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |