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General NPI Number Information
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NPI Number | 1346519444
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH CENTER OF MARSHFIELD, INC.
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Dates
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Enumeration Date | 12/19/2011
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 843 W BROADWAY AVE
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City | MEDFORD
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State | WI
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Zip | 54451-1307
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Country | US
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Telephone | 715-785-8100
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Fax | 715-785-7011
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Provider Business Mailing Address
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Address Line | PO BOX 7900 1000 N OAK AVE
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City | MARSHFIELD
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State | WI
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Zip | 54449-7900
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Country | US
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Telephone | 715-389-4574
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FAMILY HEALTH CENTER
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Name | MR. GREGORY R. NYCZ
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Credential |
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Telephone | 715-387-9137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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