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General NPI Number Information
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NPI Number | 1952390783
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Entity Type | Organization
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Legal Business Name | NORTH REACH HEALTHCARE LLC
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 11/13/2014
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Provider Practice Location 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 | 715-732-2152
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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 | 715-732-2152
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Authorized Official
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Title or Position | BUSINESS DIRECTOR
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Name | CAROL P HIPKE
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Credential |
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Telephone | 715-732-2075
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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 | 52D0710136
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #5
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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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