Basic Information
| Provider Information | |||||||||
| NPI: | 1881740975 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THIENSVILLE FAMILY HEALTH CARE SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | THIENSVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530921956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622423369 | ||||||||
| FaxNumber: | 2622423219 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | THIENSVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530921956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622423369 | ||||||||
| FaxNumber: | 2622423219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GARCIA | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2622423369 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.