Provider Demographics
NPI:1265723688
Name:PRIMARY CONNECTION HEALTH CARE, INC
Entity type:Organization
Organization Name:PRIMARY CONNECTION HEALTH CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCUDIERE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:715-848-4884
Mailing Address - Street 1:1810 N 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403
Mailing Address - Country:US
Mailing Address - Phone:715-848-4884
Mailing Address - Fax:715-845-5385
Practice Address - Street 1:401 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:MERRILL
Practice Address - State:WI
Practice Address - Zip Code:54452
Practice Address - Country:US
Practice Address - Phone:715-539-8181
Practice Address - Fax:715-539-8109
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CONNECTION HEALTH CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32956400Medicaid
000039245Medicare PIN
WI32956400Medicaid