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General NPI Number Information
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NPI Number | 1528235033
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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 | 05/14/2008
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 441 FRENCH ST
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City | PESHTIGO
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State | WI
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Zip | 54157-1203
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Country | US
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Telephone | 715-582-9949
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Fax | 715-582-4464
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Provider Business Mailing Address
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Address Line | 3120 RIVERSIDE AVE GATE B BUILDING 1
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City | MARINETTE
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State | WI
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Zip | 54143-1123
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Country | US
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Telephone | 715-732-2075
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Fax | 715-732-2072
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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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