Provider Demographics
NPI:1083846430
Name:MARSHFIELD CLINIC
Entity Type:Organization
Organization Name:MARSHFIELD CLINIC
Other - Org Name:MARSHFIELD CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR REIMBURSEMENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMENSTAD
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 1:630 S CENTRAL AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4138
Practice Address - Country:US
Practice Address - Phone:715-389-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHFIELD CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-19
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7890261QF0400X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0498280047Medicare NSC