Basic Information
Provider Information | |||||||||
NPI: | 1427111616 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MARSHFIELD CLINIC INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MARSHFIELD CLINIC PHARMACY OAKWOOD REMOTE DISPENSING SITE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: | 3501 GOLF RD STE 100 | ||||||||
Address2: |   | ||||||||
City: | EAU CLAIRE | ||||||||
State: | WI | ||||||||
PostalCode: | 547018028 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7158584224 | ||||||||
FaxNumber: | 7158584225 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/18/2006 | ||||||||
LastUpdateDate: | 10/17/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | BUKOWSKI | ||||||||
AuthorizedOfficialFirstName: | CATHERINE | ||||||||
AuthorizedOfficialMiddleName: | M | ||||||||
AuthorizedOfficialTitleorPosition: | VP FINANCE, CFO FINANCE, AO | ||||||||
AuthorizedOfficialTelephone: | 7153879370 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | MARSHFIELD CLINIC HEALTH SYSTEM INC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
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.