Healthcare Provider Details

I. General information

NPI: 1497148274
Provider Name (Legal Business Name): CUMBERLAND HC MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 16TH AVE
CUMBERLAND WI
54829-8601
US

IV. Provider business mailing address

1705 16TH AVE
CUMBERLAND WI
54829-8601
US

V. Phone/Fax

Practice location:
  • Phone: 715-822-7500
  • Fax:
Mailing address:
  • Phone: 715-822-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY DILLEY
Title or Position: CEO
Credential:
Phone: 715-822-7252