1386336436 NPI number — FAMILY HEALTH CENTER OF MARSHFIELD, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386336436 NPI number — FAMILY HEALTH CENTER OF MARSHFIELD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTH CENTER OF MARSHFIELD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LADYSMITH DENTAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386336436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1307 N SAINT JOSEPH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54449-1340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 MINER AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LADYSMITH
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54848-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-532-2500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2023

Additional Information

Authorized Official

Authorized Official Last Name:
DARRACOTT
Authorized Official First Name:
KYMBERLI
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
262-654-5555

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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