Healthcare Provider Details

I. General information

NPI: 1952027609
Provider Name (Legal Business Name): LA CLINICA DE LOS CAMPESINOS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 MAIN ST
STEVENS POINT WI
54481-4000
US

IV. Provider business mailing address

PO BOX 1440
WAUTOMA WI
54982-1440
US

V. Phone/Fax

Practice location:
  • Phone: 920-647-8126
  • Fax: 920-647-8133
Mailing address:
  • Phone: 920-787-5514
  • Fax: 920-787-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ERIN LAMORE
Title or Position: ENROLLMENT AND CONTRACT SPECIALIST
Credential:
Phone: 920-787-9459