1336553569 NPI number — FAMILY HEALTH CENTER OF MARSHFIELD, INC.

Table of content: (NPI 1336553569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336553569 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:
Provider Other Organization Name Type Code:
6
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:
1336553569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 N OAK AVE
Provider Second Line Business Mailing Address:
P. O. BOX 7900
Provider Business Mailing Address City Name:
MARSHFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54449-5703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-389-4574
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2268 N SHORE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RHINELANDER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54501-8888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-420-1400
Provider Business Practice Location Address Fax Number:
715-420-0701
Provider Enumeration Date:
06/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
NYCZ
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
DIRECTOR OF FAMILY HEALTH CENTER
Authorized Official Telephone Number:
715-387-9137

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 32958500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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