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1100 Bergslien St Baldwin WI 54002-2600 | |
(715) 684-1111 | |
(715) 684-1119 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1100 Bergslien St, Baldwin, Wisconsin |
Authorized Official Name and Position | Eilidh Pederson (CEO) |
Authorized Official Contact | 7156841100 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1100 Bergslien St Baldwin WI 54002-2600 Ph: (715) 684-1111 | 1100 Bergslien St Baldwin WI 54002-2600 Ph: (715) 684-1111 |
NPI Number | 1336228865 |
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Provider Enumeration Date | 11/03/2006 |
Last Update Date | 02/18/2022 |
Medicare PECOS PAC ID | 7911800586 |
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Medicare Enrollment ID | O20100218000035 |
Identifier | Type | State | Issuer |
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1336228865 | NPI | - | NPPES |
43058500 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 1052 (Wisconsin) | Primary |