Provider Demographics
NPI:1588857205
Name:HIGH POINT FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:HIGH POINT FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:E
Authorized Official - Last Name:STADER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-723-3100
Mailing Address - Street 1:105 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-2019
Mailing Address - Country:US
Mailing Address - Phone:608-723-3100
Mailing Address - Fax:608-723-2837
Practice Address - Street 1:105 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-2019
Practice Address - Country:US
Practice Address - Phone:608-723-3100
Practice Address - Fax:866-560-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21313300Medicaid
WI14012Medicare PIN