Provider Demographics
NPI:1891024527
Name:HSHS WISCONSIN MEDICAL GROUP INC
Entity Type:Organization
Organization Name:HSHS WISCONSIN MEDICAL GROUP INC
Other - Org Name:FAMILY HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-523-5406
Mailing Address - Street 1:2449 COUNTY HIGHWAY I
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-4410
Mailing Address - Country:US
Mailing Address - Phone:715-723-9138
Mailing Address - Fax:715-723-8633
Practice Address - Street 1:2449 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-4410
Practice Address - Country:US
Practice Address - Phone:715-723-9138
Practice Address - Fax:715-723-8633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty