Healthcare Provider Details

I. General information

NPI: 1790934651
Provider Name (Legal Business Name): HOUSE CALLS OF MENOMONIE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 09/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N BROADWAY AVE SUITE 111
MENOMONIE WI
54751-0361
US

IV. Provider business mailing address

PO BOX 361 1421 N BROADWAY AVENUE, SUITE 111
MENOMONIE WI
54751-0361
US

V. Phone/Fax

Practice location:
  • Phone: 715-232-6475
  • Fax: 715-232-6477
Mailing address:
  • Phone: 715-232-6475
  • Fax: 715-232-6477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number7917800
License Number StateWI

VIII. Authorized Official

Name: MS. DEBORAH R NOLL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 715-232-6475