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NPI Code Detail

MEDICARE: LG HEALTH

MEDICARE: LG HEALTH
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
1261QH0100XHealth Service Clinic/Center

General Provider Information

NPI Number : 1629786959
Entity Type Code : Organization
Provider Name (Legal Business Name) : LG HEALTH
Provider Business Mailing Address
First Line : 811 E WASHINGTON AVE STE 400
Second Line :
City : MADISON
State : WI
Zip : 53703-4028
Country : US
Telephone Number : 608-213-4977
Fax Number :
Provider Business Practice Location Address
First Line : 811 E WASHINGTON AVE STE 400
Second Line :
City : MADISON
State : WI
Zip : 53703-4028
Country : US
Telephone Number : 608-213-4977
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : JEFFERSON STANLEY
Credential :
Telephone Number : 608-213-4977
Provider Enumeration Date : 11/07/2022
Last Update Date : 12/19/2023

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