Healthcare Provider Details

I. General information

NPI: 1215958137
Provider Name (Legal Business Name): MINERAL POINT MEDIAL CENTER S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 HIGH ST
MINERAL POINT WI
53565-1289
US

IV. Provider business mailing address

104 HIGH ST
MINERAL POINT WI
53565-1289
US

V. Phone/Fax

Practice location:
  • Phone: 608-987-2346
  • Fax: 608-987-2490
Mailing address:
  • Phone: 608-987-2346
  • Fax: 608-987-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number855-023
License Number StateWI

VIII. Authorized Official

Name: JEAN M TOBIN
Title or Position: PAC
Credential: PAC
Phone: 608-987-2346