Provider Demographics
NPI:1497855621
Name:COUNTY OF WOOD
Entity Type:Organization
Organization Name:COUNTY OF WOOD
Other - Org Name:HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR/HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN , MPH
Authorized Official - Phone:715-421-8911
Mailing Address - Street 1:184 2ND ST N
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-4162
Mailing Address - Country:US
Mailing Address - Phone:715-421-8911
Mailing Address - Fax:715-421-8962
Practice Address - Street 1:111 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54495-2702
Practice Address - Country:US
Practice Address - Phone:715-421-8911
Practice Address - Fax:715-421-8962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41854600Medicaid
WI43077422Medicaid
WI44009400Medicaid