Provider Demographics
NPI:1497368625
Name:MDC STEVENS POINT, LLC
Entity Type:Organization
Organization Name:MDC STEVENS POINT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BOLKA
Authorized Official - Suffix:IV
Authorized Official - Credentials:CPA
Authorized Official - Phone:920-579-3188
Mailing Address - Street 1:PO BOX 1658
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54936-1658
Mailing Address - Country:US
Mailing Address - Phone:920-579-3188
Mailing Address - Fax:
Practice Address - Street 1:5541 US HIGHWAY 10 E
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8306
Practice Address - Country:US
Practice Address - Phone:715-344-7911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental