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General NPI Number Information
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NPI Number | 1720090236
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Entity Type | Organization
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Legal Business Name | WESTERN WISCONSIN MEDICAL ASSOC - NEW RICHMOND CLINIC, SC
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 551 HOSPITAL RD
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City | NEW RICHMOND
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State | WI
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Zip | 54017-1449
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Country | US
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Telephone | 715-246-6911
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Fax | 715-246-8980
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Provider Business Mailing Address
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Address Line | 551 HOSPITAL RD
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City | NEW RICHMOND
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State | WI
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Zip | 54017-1449
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Country | US
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Telephone | 715-246-6911
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Fax | 715-246-8980
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | KRIS M SPANGENBERG
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Credential |
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Telephone | 715-243-6973
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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 | 020
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License Number State | WI
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