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NPI Code Detail

MEDICARE: WEST BEND CLINIC

MEDICARE: WEST BEND 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
1332B00000XDurable Medical Equipment & Medical Supplies
2207Q00000XFamily Medicine Physician

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 : 1275542607
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST BEND CLINIC
Provider Business Mailing Address
First Line : 1700 W PARADISE DR
Second Line :
City : WEST BEND
State : WI
Zip : 53095-9795
Country : US
Telephone Number : 262-334-3451
Fax Number :
Provider Business Practice Location Address
First Line : W225N16711 CEDAR PARK CT
Second Line :
City : JACKSON
State : WI
Zip : 53037-9222
Country : US
Telephone Number : 262-677-1101
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : GREGORY G BLOMMEL
Credential :
Telephone Number : 262-334-3451
Provider Enumeration Date : 08/05/2006
Last Update Date : 05/23/2012

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Directions to “WEST BEND CLINIC ” Practice Location

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