MEDICARE: MARSHFIELD CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	8797	WI
2	261QF0400X	Federally Qualified Health Center (FQHC)	8797	WI

General Provider Information

NPI Number	:	1164654513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHFIELD CLINIC

Provider Business Mailing Address
First Line	:	1000 N OAK AVE
Second Line	:
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-5703
Country	:	US
Telephone Number	:	715-387-5511
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 ORBITING DR
Second Line	:
City	:	MOSINEE
State	:	WI
Zip	:	54455-1763
Country	:	US
Telephone Number	:	715-693-9181
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR REIMBURSEMENT
Name	:	DR. DAVID J. SIMENSTAD
Credential	:	MD
Telephone Number	:	715-387-5511

Provider Enumeration Date	:	08/19/2009
Last Update Date	:	03/08/2010

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Directions to “MARSHFIELD CLINIC ” Practice Location

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