Healthcare Provider Details

I. General information

NPI: 1629496930
Provider Name (Legal Business Name): FAMILY HEALTH CENTER OF MARSHFIELD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 LAKELAND DR
CHIPPEWA FALLS WI
54729-1687
US

IV. Provider business mailing address

1000 N. OAK AVE. P. O. BOX 7900
MARSHFIELD WI
54449-7900
US

V. Phone/Fax

Practice location:
  • Phone: 715-738-2000
  • Fax:
Mailing address:
  • Phone: 715-389-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: GREGORY R. NYCZ
Title or Position: DIRECTOR OF FAMILY HEALTH CENTER
Credential:
Phone: 715-387-9137