Provider Demographics
NPI:1295854420
Name:LANCASTER FAMILY MEDICAL CENTER S.C.
Entity Type:Organization
Organization Name:LANCASTER FAMILY MEDICAL CENTER S.C.
Other - Org Name:FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-723-4300
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-0271
Mailing Address - Country:US
Mailing Address - Phone:608-723-4300
Mailing Address - Fax:608-723-7885
Practice Address - Street 1:9177 OLD POTOSI RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-9437
Practice Address - Country:US
Practice Address - Phone:608-723-4300
Practice Address - Fax:608-723-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QP2300X261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32888000Medicaid
WI32888000Medicaid