Provider Demographics
NPI:1659767382
Name:STOCKBRIDGE-MUNSEE HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:STOCKBRIDGE-MUNSEE HEALTH AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY ASSUCANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-793-5054
Mailing Address - Street 1:W12802 COUNTY HIGHWAY A
Mailing Address - Street 2:PO BOX 86
Mailing Address - City:BOWLER
Mailing Address - State:WI
Mailing Address - Zip Code:54416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:W12802 COUNTY HIGHWAY A
Practice Address - Street 2:
Practice Address - City:BOWLER
Practice Address - State:WI
Practice Address - Zip Code:54416
Practice Address - Country:US
Practice Address - Phone:715-793-4144
Practice Address - Fax:715-793-4120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care