Healthcare Provider Details

I. General information

NPI: 1740029727
Provider Name (Legal Business Name): CHIPPEWA VALLEY HEALTH COOPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27373 126TH ST
NEW AUBURN WI
54757-5102
US

IV. Provider business mailing address

16078 93RD AVE
CHIPPEWA FALLS WI
54729-5169
US

V. Phone/Fax

Practice location:
  • Phone: 715-829-1655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA QUICK
Title or Position: CONSULTANT
Credential:
Phone: 715-379-7820