Healthcare Provider Details

I. General information

NPI: 1598765125
Provider Name (Legal Business Name): COUNTY OF BURNETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 COUNTY ROAD K SUITE 280
SIREN WI
54872-9070
US

IV. Provider business mailing address

7410 COUNTY ROAD K SUITE 280
SIREN WI
54872-9070
US

V. Phone/Fax

Practice location:
  • Phone: 715-349-7600
  • Fax: 715-349-2145
Mailing address:
  • Phone: 715-349-7600
  • Fax: 715-349-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2630
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateWI

VIII. Authorized Official

Name: STACY HOPKE
Title or Position: FISCAL COORDINATOR
Credential:
Phone: 715-349-7600