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General NPI Number Information
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NPI Number | 1326198367
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Entity Type | Organization
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Legal Business Name | INGALLS FAMILY MEDICINE CLINIC SC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7456 MAIN ST W
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City | WEBSTER
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State | WI
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Zip | 54893-8205
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Country | US
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Telephone | 715-866-4271
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Fax | 715-866-4284
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Provider Business Mailing Address
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Address Line | 7456 MAIN ST W
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City | WEBSTER
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State | WI
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Zip | 54893-8205
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Country | US
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Telephone | 715-866-4271
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Fax | 715-866-4284
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Authorized Official
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Title or Position | OWNER
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Name | JOHN W INGALLS
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Credential | MD
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Telephone | 715-866-4271
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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 | 31328
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License Number State | WI
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