Healthcare Provider Details

I. General information

NPI: 1508854464
Provider Name (Legal Business Name): DOUGLAS COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 N 14TH ST STE 400
SUPERIOR WI
54880-1773
US

IV. Provider business mailing address

1316 N 14TH ST STE 400 OR SUITE 324
SUPERIOR WI
54880-1773
US

V. Phone/Fax

Practice location:
  • Phone: 715-395-1304
  • Fax: 715-395-1434
Mailing address:
  • Phone: 715-395-1304
  • Fax: 715-395-1434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA ANN SCHANEN
Title or Position: DIRECTOR DOUGLAS COUNTY HEALTH
Credential:
Phone: 715-395-1304