Basic Information
| Provider Information | |||||||||
| NPI: | 1407919608 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARSHFIELD CLINIC INC | ||||||||
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| OtherOrganizationName: | MARSHFIELD CLINIC PHARMACY RIVERVIEW REMOTE DISPENSING SITE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 N OAK AVE | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT COORDINATOR SHP FL 2 | ||||||||
| City: | MARSHFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544495703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153890660 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1000 STARR AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547031821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158584366 | ||||||||
| FaxNumber: | 7158584367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2006 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | BUKOWSKI | ||||||||
| AuthorizedOfficialFirstName: | CATHERINE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE, CFO FINANCE, AO | ||||||||
| AuthorizedOfficialTelephone: | 7153879370 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MARSHFIELD CLINIC HEALTH SYSTEM INC | ||||||||
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| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 3336C0002X | Y | Suppliers | Pharmacy | Clinic Pharmacy |
No ID Information.