Provider Demographics
NPI: | 1881186948 |
---|---|
Name: | MARSHFIELD CLINIC, INC. |
Entity Type: | Organization |
Organization Name: | MARSHFIELD CLINIC, INC. |
Other - Org Name: | MARSHFIELD CLINIC SPECIALTY PHARMACY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | MEDICAL DIRECTOR REIMBURSEMENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MATTHEW |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | THOMAS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 715-387-5511 |
Mailing Address - Street 1: | 1000 N OAK AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | MARSHFIELD |
Mailing Address - State: | WI |
Mailing Address - Zip Code: | 54449-5703 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 715-387-5511 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1000 N OAK AVE STE 300 |
Practice Address - Street 2: | |
Practice Address - City: | MARSHFIELD |
Practice Address - State: | WI |
Practice Address - Zip Code: | 54449-5703 |
Practice Address - Country: | US |
Practice Address - Phone: | 715-387-5511 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | MARSHFIELD CLINIC, INC. |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2018-06-05 |
Last Update Date: | 2018-06-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |