Healthcare Provider Details

I. General information

NPI: 1326162702
Provider Name (Legal Business Name): TWO RIVERS CLINIC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAIN STREET
EAU CLAIRE WI
54701
US

IV. Provider business mailing address

200 MAIN STREET
EAU CLAIRE WI
54701
US

V. Phone/Fax

Practice location:
  • Phone: 715-855-8280
  • Fax: 715-855-8283
Mailing address:
  • Phone: 715-855-8280
  • Fax: 715-855-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL MITCHELL SCHLOSSER
Title or Position: OWNER OPERATOR PHYSICIAN
Credential: MD
Phone: 715-855-8280