Healthcare Provider Details

I. General information

NPI: 1760574933
Provider Name (Legal Business Name): FAMILY MEDICAL CENTER, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 TIERNEY DRIVE
NEW RICHMOND WI
54017-2515
US

IV. Provider business mailing address

246 TIERNEY DRIVE
NEW RICHMOND WI
54017-2515
US

V. Phone/Fax

Practice location:
  • Phone: 715-246-2521
  • Fax: 715-246-7977
Mailing address:
  • Phone: 715-246-2521
  • Fax: 715-246-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY KRUSCHKE
Title or Position: OFFICE MANAGER
Credential:
Phone: 715-246-2521