MEDICARE: LA CLINICA DE LOS CAMPESINOS, INC

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
1	3336C0002X	Clinic Pharmacy

Other Identifiers

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

General Provider Information

NPI Number	:	1952027609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA CLINICA DE LOS CAMPESINOS, INC

Provider Business Mailing Address
First Line	:	PO BOX 1440
Second Line	:
City	:	WAUTOMA
State	:	WI
Zip	:	54982-1440
Country	:	US
Telephone Number	:	920-787-5514
Fax Number	:	920-787-4737

Provider Business Practice Location Address
First Line	:	2501 MAIN ST
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-4000
Country	:	US
Telephone Number	:	920-647-8126
Fax Number	:	920-647-8133

Authorized Official
Title or Position	:	ENROLLMENT AND CONTRACT SPECIALIST
Name	:	ERIN LAMORE
Credential	:
Telephone Number	:	920-787-9459

Provider Enumeration Date	:	10/14/2022
Last Update Date	:	11/20/2025

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