Healthcare Provider Details

I. General information

NPI: 1598108284
Provider Name (Legal Business Name): COMMUNITY CLINIC OF DOOR COUNTY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 RHODE ISLAND ST
STURGEON BAY WI
54235-1424
US

IV. Provider business mailing address

PO BOX 3
STURGEON BAY WI
54235-0003
US

V. Phone/Fax

Practice location:
  • Phone: 920-746-8989
  • Fax: 920-746-8960
Mailing address:
  • Phone: 920-746-8989
  • Fax: 920-746-8960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPHINE GUENZEL
Title or Position: BOARD SECRETARY
Credential:
Phone: 920-746-8989