Provider Demographics
NPI:1043377831
Name:SPRING CITY HEALTH CENTRE
Entity Type:Organization
Organization Name:SPRING CITY HEALTH CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-547-3055
Mailing Address - Street 1:403 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4913
Mailing Address - Country:US
Mailing Address - Phone:262-547-3055
Mailing Address - Fax:
Practice Address - Street 1:403 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4913
Practice Address - Country:US
Practice Address - Phone:262-547-3055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF38732Medicare UPIN
WIS92024Medicare UPIN