| |
913 East Main Street Suring WI 54174 | |
(920) 842-1147 | |
(920) 842-1160 |
Full Name | |
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Speciality | Clinic/Center |
Location | 913 East Main Street, Suring, 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 | 913 East Main Street Suring WI 54174 Ph: (920) 842-1147 |
NPI Number | 1750412292 |
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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 | O20100623000659 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750412292 | NPI | - | NPPES |
1851477913 | Other | CMH NPI | |
1003898867 | Other | WI | ZAHN NPI |
32843600 | Medicaid | WI | |
11014110 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
363L00000X | Nurse Practitioner | 54392-030 (Wisconsin) | Secondary |