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General NPI Number Information
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NPI Number | 1528244613
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Entity Type | Organization
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Legal Business Name | ROCK RIVER COMMUNITY CLINIC, INC
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 520 HANDEYSIDE SUITE 4
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City | FORT ATKINSON
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State | WI
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Zip | 53538
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Country | US
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Telephone | 920-563-4372
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Fax | 920-463-4374
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Provider Business Mailing Address
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Address Line | 520 HANDEYSIDE LN STE 4
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City | FORT ATKINSON
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State | WI
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Zip | 53538-1279
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Country | US
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Telephone | 920-563-4372
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Fax | 920-463-4374
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Authorized Official
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Title or Position | MANAGER
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Name | MISS ABE MARTINEZ
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Credential |
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Telephone | 920-563-4372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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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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