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NPI Code Detail

MEDICARE: COUNTY OF GRANT

MEDICARE: COUNTY OF GRANT
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
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588618789
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTY OF GRANT
Provider Business Mailing Address
First Line : 200 W ALONA LN
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2202
Country : US
Telephone Number : 608-723-6357
Fax Number : 608-723-4417
Provider Business Practice Location Address
First Line : 200 W ALONA LN
Second Line :
City : LANCASTER
State : WI
Zip : 53813-2202
Country : US
Telephone Number : 608-723-6357
Fax Number : 608-723-4417
Authorized Official
Title or Position : COMPTROLLER
Name : JAN SUDMEIER
Credential : BS
Telephone Number : 608-723-6357
Provider Enumeration Date : 05/20/2006
Last Update Date : 04/23/2009

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Directions to “COUNTY OF GRANT ” Practice Location

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