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General NPI Number Information
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NPI Number | 1134202062
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Entity Type | Organization
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Legal Business Name | POUND COMMUNITY MEDICAL CLINIC S.C.
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 2026 COUNTY ROAD Q
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City | POUND
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State | WI
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Zip | 54161-9707
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Country | US
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Telephone | 920-897-2331
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Fax | 920-897-2115
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Provider Business Mailing Address
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Address Line | 2026 COUNTY ROAD Q
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City | POUND
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State | WI
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Zip | 54161-9707
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Country | US
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Telephone | 920-897-2331
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Fax | 920-897-2115
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOHN KELLOGG MCGUIRE
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Credential | M.D.
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Telephone | 920-897-2331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25995
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License Number State | WI
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