Provider Demographics
NPI:1275691792
Name:CADOTT MEDICAL CENTER SC
Entity Type:Organization
Organization Name:CADOTT MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-289-4221
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:322 N MAIN ST
Mailing Address - City:CADOTT
Mailing Address - State:WI
Mailing Address - Zip Code:54727
Mailing Address - Country:US
Mailing Address - Phone:715-289-4221
Mailing Address - Fax:715-289-3534
Practice Address - Street 1:322 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CADOTT
Practice Address - State:WI
Practice Address - Zip Code:54727
Practice Address - Country:US
Practice Address - Phone:715-289-4221
Practice Address - Fax:715-289-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32856500Medicaid
WI3099430Medicaid