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NPI Code Detail

MEDICARE: INTERRA HEALTH INC.

MEDICARE: INTERRA HEALTH 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
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1760035513
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERRA HEALTH INC.
Provider Business Mailing Address
First Line : 8919 W HEATHER AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53224-2417
Country : US
Telephone Number : 414-375-1600
Fax Number : 414-375-1636
Provider Business Practice Location Address
First Line : 831 SIMPSON RD
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-5328
Country : US
Telephone Number : 407-483-5757
Fax Number : 407-483-5756
Authorized Official
Title or Position : IMPLEMENTATION & TRAINING COORD
Name : MICHELLE D RUTH
Credential :
Telephone Number : 262-375-2827
Provider Enumeration Date : 07/22/2019
Last Update Date : 07/22/2019

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