Healthcare Provider Details

I. General information

NPI: 1548437155
Provider Name (Legal Business Name): CRIVITZ MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S HWY 141
CRIVITZ WI
54114
US

IV. Provider business mailing address

218 S HWY 141
CRIVITZ WI
54114-1677
US

V. Phone/Fax

Practice location:
  • Phone: 715-732-2075
  • Fax: 715-732-2072
Mailing address:
  • Phone: 715-854-7477
  • Fax: 715-854-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES P QUARTANA
Title or Position: CEO
Credential:
Phone: 715-732-2075