Healthcare Provider Details

I. General information

NPI: 1629091566
Provider Name (Legal Business Name): CUMBERLAND CLINIC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 WEBB ST
CUMBERLAND WI
54829
US

IV. Provider business mailing address

1475 WEBB ST PO BOX 127
CUMBERLAND WI
54829
US

V. Phone/Fax

Practice location:
  • Phone: 715-822-2231
  • Fax: 715-822-2023
Mailing address:
  • Phone: 715-822-2231
  • Fax: 715-822-2023

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: MICHAEL R NELLI
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-822-2231