MEDICARE: LICE CLINICS OF AMERICA CENTRAL WI LLC

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1891221461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LICE CLINICS OF AMERICA CENTRAL WI LLC

Provider Business Mailing Address
First Line	:	2819 POST RD
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-6416
Country	:	US
Telephone Number	:	715-570-4887
Fax Number	:

Provider Business Practice Location Address
First Line	:	2819 POST RD
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54481-6416
Country	:	US
Telephone Number	:	715-570-4887
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	LAURIE MOYER
Credential	:
Telephone Number	:	715-570-4887

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	05/02/2017

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