| Random Lake Medical Center Llc | |
|
N639 Silver Creek Cascade Road Random Lake WI 53075 | |
| (920) 994-9999 | |
| (920) 994-9998 |
| Full Name | Random Lake Medical Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | N639 Silver Creek Cascade Road, Random Lake, Wisconsin |
| Authorized Official Name and Position | Barbara A Weber (OWNER) |
| Authorized Official Contact | 9209949999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Random Lake Medical Center Llc Po Box 246 N639 Silver Creek Cascade Rd Random Lake WI 53075 Ph: (920) 994-9999 | Random Lake Medical Center Llc N639 Silver Creek Cascade Road Random Lake WI 53075 Ph: (920) 994-9999 |
| NPI Number | 1285854240 |
|---|---|
| Provider Enumeration Date | 05/01/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285854240 | NPI | - | NPPES |
| 32420000 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 39774 (Wisconsin) | Primary |
Random Lake Spine & Sports Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 321 Carroll St., Random Lake, WI 53075 Phone: 920-994-2000 | |
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