| |
200 S. Rosera Street Lena WI 54139 | |
(920) 829-6400 | |
(920) 829-6403 |
Full Name | |
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Speciality | Clinic/Center |
Location | 200 S. Rosera Street, Lena, Wisconsin |
Authorized Official Name and Position | Patricia Allen (CFO) |
Authorized Official Contact | 9208845660 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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855 S Main St Oconto Falls WI 54154-1241 Ph: (920) 846-3444 | 200 S. Rosera Street Lena WI 54139 Ph: (920) 829-6400 |
NPI Number | 1346371358 |
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Provider Enumeration Date | 03/08/2007 |
Last Update Date | 03/21/2024 |
Medicare PECOS PAC ID | 0446211395 |
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Medicare Enrollment ID | O20100623000713 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346371358 | NPI | - | NPPES |
11014110 | Medicaid | WI | |
3987482411009 | Other | WI | RICHLEN BC |
294946191003 | Other | WI | CUPINO BC |
1851477913 | Other | CMH NPI | |
41969700 | Medicaid | WI | |
32392300 | Medicaid | WI |