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NPI Code Detail

MEDICARE: PREMIER PHYSICAL MEDICINE AND WELLNESS CLINIC

MEDICARE: PREMIER PHYSICAL MEDICINE AND WELLNESS CLINIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician33657WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104913623
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER PHYSICAL MEDICINE AND WELLNESS CLINIC
Provider Business Mailing Address
First Line : PO BOX 1550
Second Line :
City : WOODRUFF
State : WI
Zip : 54568-1550
Country : US
Telephone Number : 715-356-9999
Fax Number : 715-356-9894
Provider Business Practice Location Address
First Line : 1446 1ST AVE
Second Line :
City : WOODRUFF
State : WI
Zip : 54568-9149
Country : US
Telephone Number : 715-356-9999
Fax Number : 715-356-9894
Authorized Official
Title or Position : OWNER
Name : JAMES E MULLEN
Credential : M.D.
Telephone Number : 715-356-9999
Provider Enumeration Date : 10/06/2006
Last Update Date : 01/08/2009

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Directions to “PREMIER PHYSICAL MEDICINE AND WELLNESS CLINIC ” Practice Location

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