MEDICARE: FAMILY HEALTH CENTER OF MARSHFIELD, INC.

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
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1710321757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH CENTER OF MARSHFIELD, INC.

Provider Business Mailing Address
First Line	:	1000 N OAK AVE
Second Line	:	P.O. BOX 7900
City	:	MARSHFIELD
State	:	WI
Zip	:	54449-5703
Country	:	US
Telephone Number	:	715-389-4574
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S WISCONSIN AVE
Second Line	:
City	:	STRATFORD
State	:	WI
Zip	:	54484-9692
Country	:	US
Telephone Number	:	715-221-8790
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF FAMILY HEALTH CENTER
Name	:	GREGORY R NYCZ
Credential	:	MD
Telephone Number	:	715-387-9137

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	06/15/2016

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