Provider Demographics
NPI:1083026678
Name:MARSHFIELD CLINIC, INC.
Entity Type:Organization
Organization Name:MARSHFIELD CLINIC, INC.
Other - Org Name:MARSHFIELD CLINIC CENTRAL PLAZA ORTHOTICS/PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER, MARSHFIELD CLINIC, INC.
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-387-5511
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-387-5511
Mailing Address - Fax:
Practice Address - Street 1:200 E UPHAM ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1543
Practice Address - Country:US
Practice Address - Phone:715-387-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHFIELD CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-30
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0498280062Medicare NSC