|
| |
|
15397 State Highway 32 Lakewood WI 54138-9702 | |
| (715) 276-6321 | |
| (715) 276-1428 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 15397 State Highway 32, Lakewood, Wisconsin |
| Authorized Official Name and Position | Reba Rice (CEO) |
| Authorized Official Contact | 7153725001 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 179 Lakewood WI 54138-0179 Ph: (715) 276-6321 | 15397 State Highway 32 Lakewood WI 54138-9702 Ph: (715) 276-6321 |
| NPI Number | 1699778233 |
|---|---|
| Provider Enumeration Date | 05/27/2005 |
| Last Update Date | 03/19/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699778233 | NPI | - | NPPES |
| 3295500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 4757-800 (Wisconsin) | Primary |
Assure Family Practice Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 17187 Twin Pines Rd, Suite A, Lakewood, WI 54138 Phone: 715-850-0700 Fax: 866-484-2182 | |