Healthcare Provider Details

I. General information

NPI: 1730109349
Provider Name (Legal Business Name): PARTNERSHIP HEALTH PLAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 EASTRIDGE CTR
EAU CLARIE WI
54701-3410
US

IV. Provider business mailing address

2240 EASTRIDGE CTR
EAU CLARIE WI
54701-3410
US

V. Phone/Fax

Practice location:
  • Phone: 715-838-2900
  • Fax: 715-838-2910
Mailing address:
  • Phone: 715-838-2900
  • Fax: 715-838-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: KAREN A BULLOCK
Title or Position: CEO
Credential:
Phone: 715-838-2901