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NPI Code Detail

MEDICARE: PREVEA CLINIC, INC.

MEDICARE: PREVEA CLINIC, 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
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1780713339
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREVEA CLINIC, INC.
Provider Business Mailing Address
First Line : PO BOX 13008
Second Line :
City : GREEN BAY
State : WI
Zip : 54307-3008
Country : US
Telephone Number : 920-496-4700
Fax Number :
Provider Business Practice Location Address
First Line : 620 SMITH AVE
Second Line :
City : OCONTO
State : WI
Zip : 54153-1080
Country : US
Telephone Number : 920-496-4700
Fax Number :
Authorized Official
Title or Position : PRESIDENT & CEO
Name : ASHOK RAI
Credential : MD
Telephone Number : 920-496-4700
Provider Enumeration Date : 03/02/2007
Last Update Date : 01/12/2022

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Directions to “PREVEA CLINIC, INC. ” Practice Location

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