Provider Demographics
NPI:1700043858
Name:NORTHPOINT MEDICAL & REHAB CENTER
Entity Type:Organization
Organization Name:NORTHPOINT MEDICAL & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:920-233-4011
Mailing Address - Street 1:1850 BOWEN ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2356
Mailing Address - Country:US
Mailing Address - Phone:920-233-4011
Mailing Address - Fax:920-233-2641
Practice Address - Street 1:1850 BOWEN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2356
Practice Address - Country:US
Practice Address - Phone:920-233-4011
Practice Address - Fax:920-233-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3752028225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40873100Medicaid