Healthcare Provider Details

I. General information

NPI: 1295106318
Provider Name (Legal Business Name): ASTIA HEALTH CLINICAL SERVICES, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S CENTRAL AVE STE 303
MARSHFIELD WI
54449-4196
US

IV. Provider business mailing address

664 COMMUNITY CIRCLE
MARATHON WI
54448
US

V. Phone/Fax

Practice location:
  • Phone: 888-885-4434
  • Fax:
Mailing address:
  • Phone: 888-885-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER L. SOMMERS
Title or Position: CEO
Credential: MD
Phone: 414-350-4400