Provider Demographics
NPI:1558705723
Name:FAMILY HEALTH CENTER OF MARSHFIELD, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER OF MARSHFIELD, INC.
Other - Org Name:FAMILY HEALTH CENTER/MARSHFIELD CLINIC-CORNELL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FAMILY HEALTH CENTER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NYCZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-387-9137
Mailing Address - Street 1:1000 N OAK AVE
Mailing Address - Street 2:P.O. BOX 7900
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-5703
Mailing Address - Country:US
Mailing Address - Phone:715-389-4574
Mailing Address - Fax:
Practice Address - Street 1:600 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:CORNELL
Practice Address - State:WI
Practice Address - Zip Code:54732-8003
Practice Address - Country:US
Practice Address - Phone:715-239-6344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH CENTER OF MARSHFIELD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-18
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies