Basic Information
| Provider Information | |||||||||
| NPI: | 1497155808 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY HEALTH CENTER OF MARSHFIELD, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FHC MENOMONIE DME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 N OAK AVE | ||||||||
| Address2: | P. O. BOX 7900 | ||||||||
| City: | MARSHFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544495703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153894574 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3603 SCHNEIDER AVE SE | ||||||||
| Address2: | |||||||||
| City: | MENOMONIE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547515674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152336400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2014 | ||||||||
| LastUpdateDate: | 06/15/2016 | ||||||||
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| AuthorizedOfficialLastName: | NYCZ | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FAMILY HEALTH CENTER | ||||||||
| AuthorizedOfficialTelephone: | 7153879137 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FAMILY HEALTH CENTER OF MARSHFIELD, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.