Provider Demographics
NPI:1467641738
Name:MARSHFIELD CLINIC
Entity Type:Organization
Organization Name:MARSHFIELD CLINIC
Other - Org Name:MARSHFIELD CLINIC/CLAIREMONT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR REIMBURSEMENT
Authorized Official - Prefix:
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 1:1002 W CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6123
Practice Address - Country:US
Practice Address - Phone:715-858-4694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHFIELD CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-23
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0498280067Medicare NSC