Provider Demographics
NPI:1407307374
Name:INTERRA HEALTH INC.
Entity Type:Organization
Organization Name:INTERRA HEALTH INC.
Other - Org Name:MPC INHEALTH CLINIC TN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IMPLEMENTATION & TRAINING COODINATO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-375-1600
Mailing Address - Street 1:8919 W HEATHER AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2417
Mailing Address - Country:US
Mailing Address - Phone:414-375-1600
Mailing Address - Fax:414-375-1639
Practice Address - Street 1:120 BROST DR
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:TN
Practice Address - Zip Code:37357-1500
Practice Address - Country:US
Practice Address - Phone:931-635-4600
Practice Address - Fax:931-635-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care