Healthcare Provider Details

I. General information

NPI: 1912078718
Provider Name (Legal Business Name): EAU CLAIRE GI ASSOCIATES SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4109 OAKWOOD HILLS PARKWAY
EAU CLAIRE WI
54701-8888
US

IV. Provider business mailing address

4109 OAKWOOD HILLS PARKWAY
EAU CLAIRE WI
54701-8888
US

V. Phone/Fax

Practice location:
  • Phone: 715-552-7303
  • Fax: 715-552-7355
Mailing address:
  • Phone: 715-552-7303
  • Fax: 715-552-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number37801-020
License Number StateWI

VIII. Authorized Official

Name: AMY FOGELTANZ
Title or Position: PRACTICE MANAGER
Credential:
Phone: 715-552-7303