Provider Demographics
NPI:1659600575
Name:NORTHREACH HEALTHCARE LAB AND XRAY
Entity Type:Organization
Organization Name:NORTHREACH HEALTHCARE LAB AND XRAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-735-8046
Mailing Address - Street 1:3123 SHORE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4287
Mailing Address - Country:US
Mailing Address - Phone:715-735-8046
Mailing Address - Fax:715-735-8047
Practice Address - Street 1:3123 SHORE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4287
Practice Address - Country:US
Practice Address - Phone:715-735-8046
Practice Address - Fax:715-735-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52-D0394498291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory