Provider Demographics
NPI:1619915741
Name:KLASINSKI CLINIC, S.C.
Entity Type:Organization
Organization Name:KLASINSKI CLINIC, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHASE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEHRENDT
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:715-344-2164
Mailing Address - Street 1:500 VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1848
Mailing Address - Country:US
Mailing Address - Phone:715-344-0701
Mailing Address - Fax:715-344-4494
Practice Address - Street 1:500 VINCENT ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1848
Practice Address - Country:US
Practice Address - Phone:715-344-0701
Practice Address - Fax:715-344-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
WI0917050001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30670500Medicaid
WI31827000Medicaid
WI42969800Medicaid
WI42986500Medicaid
WI32144600Medicaid
WI32166500Medicaid
WICP7737OtherPALMETTO GBA-RR MEDICARE
WIF32274Medicare UPIN
000150105Medicare ID - Type Unspecified
WI31827000Medicaid
WI000050105Medicare PIN
WICP7737OtherPALMETTO GBA-RR MEDICARE
WI32144600Medicaid
WI32166500Medicaid
WI42986500Medicaid
000250105Medicare ID - Type Unspecified
WI30670500Medicaid