1811268204 NPI number — NORTHREACH HEALTHCARE LLC

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 1811268204 NPI number — NORTHREACH HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHREACH HEALTHCARE LLC
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:
AFTER HOURS CLINIC
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:
1811268204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22487
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54305-2487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-445-7226
Provider Business Mailing Address Fax Number:
920-445-7229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1106 UNIVERSITY DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MARINETTE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54143-5110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-732-2075
Provider Business Practice Location Address Fax Number:
715-735-0895
Provider Enumeration Date:
01/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
STROOBANTS
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
920-445-7226

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 52D2038176 . This is a "CLINIC CLIA" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com