Provider Demographics
NPI:1023400819
Name:OAKLEAF CLINICS SC
Entity Type:Organization
Organization Name:OAKLEAF CLINICS SC
Other - Org Name:OAKLEAF CLINICS, SC - OB-GYN CLINIC OF EAU CLAIRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:LONGBELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-836-9242
Mailing Address - Street 1:719 W HAMILTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6970
Mailing Address - Country:US
Mailing Address - Phone:715-552-9784
Mailing Address - Fax:715-835-6370
Practice Address - Street 1:1110 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6133
Practice Address - Country:US
Practice Address - Phone:715-834-9998
Practice Address - Fax:715-834-9833
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKLEAF CLINICS, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-03
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty