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General NPI Number Information
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NPI Number | 1659600575
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Entity Type | Organization
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Legal Business Name | NORTHREACH HEALTHCARE LAB AND XRAY
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Dates
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Enumeration Date | 12/24/2009
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Last Update Date | 12/24/2009
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Provider Practice Location Address
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Address Line | 3123 SHORE DR SUITE 103
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City | MARINETTE
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State | WI
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Zip | 54143-4287
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Country | US
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Telephone | 715-735-8046
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Fax | 715-735-8047
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Provider Business Mailing Address
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Address Line | 3123 SHORE DR SUITE 103
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City | MARINETTE
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State | WI
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Zip | 54143-4287
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Country | US
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Telephone | 715-735-8046
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Fax | 715-735-8047
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CALVIN NOGLER
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Credential | MD
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Telephone | 715-735-8046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 52-D0394498
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License Number State | WI
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