Healthcare Provider Details

I. General information

NPI: 1619915741
Provider Name (Legal Business Name): KLASINSKI CLINIC, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VINCENT ST
STEVENS POINT WI
54481-1848
US

IV. Provider business mailing address

500 VINCENT ST
STEVENS POINT WI
54481-1848
US

V. Phone/Fax

Practice location:
  • Phone: 715-344-0701
  • Fax: 715-344-4494
Mailing address:
  • Phone: 715-344-0701
  • Fax: 715-344-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0917050001
License Number StateWI

VIII. Authorized Official

Name: MR. CHASE L BEHRENDT
Title or Position: ADMINISTRATOR
Credential: MBA
Phone: 715-344-2164