Provider Demographics
NPI:1427218379
Name:J-1 ENTERPRISES LLC
Entity Type:Organization
Organization Name:J-1 ENTERPRISES LLC
Other - Org Name:HEALTHSOURCE OF MARSHFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-384-9064
Mailing Address - Street 1:106 S CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-2741
Mailing Address - Country:US
Mailing Address - Phone:715-384-9064
Mailing Address - Fax:715-387-6954
Practice Address - Street 1:106 S CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-2741
Practice Address - Country:US
Practice Address - Phone:715-384-9064
Practice Address - Fax:715-387-6954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:J-1ENTERPRISES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-13
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service