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General NPI Number Information
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NPI Number | 1558718874
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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 | 05/17/2016
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Last Update Date | 05/17/2016
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Provider Practice Location Address
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Address Line | 9792 HWY 70
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City | MINOCQUA
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State | WI
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Zip | 54548-8747
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Country | US
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Telephone | 715-358-1208
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 N OAK AVE
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City | MARSHFIELD
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State | WI
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Zip | 54449-5703
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Country | US
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Telephone | 715-389-0780
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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 | 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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | WI
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