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General NPI Number Information
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NPI Number | 1295872570
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Entity Type | Organization
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Legal Business Name | NORTHREACH HEALTHCARE, LLC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 11/01/2011
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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 CO. HWY. Q
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City | POUND
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State | WI
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Zip | 54143
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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 | DIRECTOR OF BUSINESS SERVICES
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Name | CAROL HIPKE
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Credential |
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Telephone | 715-732-2078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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