Provider Demographics
NPI:1639843121
Name:PIIC CLINICAL SERVICES, PC
Entity Type:Organization
Organization Name:PIIC CLINICAL SERVICES, PC
Other - Org Name:CAMPUS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CLIENT & CARE STRATEGY
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALSNE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:952-698-9860
Mailing Address - Street 1:323 WASHINGTON AVE N STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-2206
Mailing Address - Country:US
Mailing Address - Phone:952-698-9860
Mailing Address - Fax:612-930-0106
Practice Address - Street 1:1477 KENWOOD DR STE 201
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1160
Practice Address - Country:US
Practice Address - Phone:920-967-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care