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210 Washington Street Wausau WI 54403-5475 | |
(715) 845-3637 | |
(715) 845-1977 |
Full Name | |
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Speciality | Clinic/center |
Location | 210 Washington Street, Wausau, Wisconsin |
Authorized Official Name and Position | Brian Phillip Farley (VP & SECRETARY) |
Authorized Official Contact | 6158616000 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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6183 Paseo Del Norte. Ste 200 Carlsbad CA 92011-1155 Ph: (855) 259-2288 | 210 Washington Street Wausau WI 54403-5475 Ph: (715) 845-3637 |
NPI Number | 1881942845 |
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Provider Enumeration Date | 08/24/2012 |
Last Update Date | 10/24/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881942845 | NPI | - | NPPES |
100055685 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | 2408 (Wisconsin) | Primary |
Spine & Brain Group Sc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2800 Westhill Dr, Suite 200, Wausau, WI 54401 Phone: 715-843-1000 Fax: 715-843-1001 |