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NPI Code Detail

MEDICARE: COUNTY OF SHAWANO

MEDICARE: COUNTY OF SHAWANO
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
1315P00000XIntellectual Disabilities Intermediate Care Facility2994WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720088495
Entity Type Code : Organization
Provider Name (Legal Business Name) : COUNTY OF SHAWANO
Provider Business Mailing Address
First Line : N4231 STATE HIGHWAY 22
Second Line :
City : SHAWANO
State : WI
Zip : 54166-6130
Country : US
Telephone Number : 715-526-3158
Fax Number : 715-526-6823
Provider Business Practice Location Address
First Line : N4231 STATE HIGHWAY 22
Second Line :
City : SHAWANO
State : WI
Zip : 54166-6130
Country : US
Telephone Number : 715-526-3158
Fax Number : 715-526-6823
Authorized Official
Title or Position : ACCOUNTANT/CONTROLLER
Name : MRS. DEBBRA R KESSEN
Credential :
Telephone Number : 715-526-3158
Provider Enumeration Date : 07/26/2005
Last Update Date : 09/10/2007

Similar Medicare Providers

1124028519 — COUNTY OF SHAWANO
Practice Location Address:
N4231 STATE HIGHWAY 22
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54166-6130
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1003178807 — MARK SCOTT HERBERT
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SHAWANO, WI
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1922546712 — NICHOLAS THIEL PTA
Practice Location Address:
N4231 STATE HIGHWAY 22
SHAWANO, WI
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1619510567 — NSH SHAWANO-MAPLE LLC
Practice Location Address:
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Directions to “COUNTY OF SHAWANO ” Practice Location

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