Provider Demographics
NPI:1508033184
Name:TREMPEALEAU CO HEALTH DEPT
Entity Type:Organization
Organization Name:TREMPEALEAU CO HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAWEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-538-2311
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:36245 MAIN ST
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-0067
Mailing Address - Country:US
Mailing Address - Phone:715-538-2311
Mailing Address - Fax:715-538-4861
Practice Address - Street 1:36245 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773
Practice Address - Country:US
Practice Address - Phone:715-538-2311
Practice Address - Fax:715-538-4861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI107251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41854900Medicaid