Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 14353 Hwy 32/64, Mountain, 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 |
---|---|
855 S Main St Oconto Falls WI 54154-1241 Ph: (920) 846-3444 | 14353 Hwy 32/64 Mountain WI 54149 Ph: (715) 276-1600 |
NPI Number | 1568552958 |
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Provider Enumeration Date | 10/13/2006 |
Last Update Date | 03/21/2024 |
Medicare PECOS PAC ID | 0446211395 |
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Medicare Enrollment ID | O20100805000249 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568552958 | NPI | - | NPPES |
1316940927 | Other | WI | GREMBAN NPI |
1689677213 | Other | WI | BOLLENBACH NPI |
1851477913 | Other | CMH NPI | |
11014110 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 23967-020 (Wisconsin) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |