1376605246 NPI number — STOIBER HEALTHCARE S.C.

Table of content: (NPI 1376605246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376605246 NPI number — STOIBER HEALTHCARE S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STOIBER HEALTHCARE S.C.
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:
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:
1376605246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1210 PARKWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WISCONSIN RAPIDS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54494-5488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-424-4646
Provider Business Mailing Address Fax Number:
715-424-3354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1210 PARKWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WISCONSIN RAPIDS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54494-5488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-424-4646
Provider Business Practice Location Address Fax Number:
715-424-3354
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STOIBER
Authorized Official First Name:
MOZELLE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
715-424-4646

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  649315-9 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38991600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK9304 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com