Provider Demographics
NPI:1295973964
Name:THE HEALTH PLACE
Entity type:Organization
Organization Name:THE HEALTH PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:920-424-1242
Mailing Address - Street 1:510 DOCTORS CT
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-2026
Mailing Address - Country:US
Mailing Address - Phone:920-424-1242
Mailing Address - Fax:920-424-2045
Practice Address - Street 1:510 DOCTORS CT
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-2026
Practice Address - Country:US
Practice Address - Phone:920-424-1242
Practice Address - Fax:920-424-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
86808Medicare PIN
WI41869600Medicare Oscar/Certification