Provider Demographics
NPI:1740029727
Name:CHIPPEWA VALLEY HEALTH COOPERATIVE
Entity type:Organization
Organization Name:CHIPPEWA VALLEY HEALTH COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-379-7820
Mailing Address - Street 1:16078 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-5169
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27373 126TH ST
Practice Address - Street 2:
Practice Address - City:NEW AUBURN
Practice Address - State:WI
Practice Address - Zip Code:54757-5102
Practice Address - Country:US
Practice Address - Phone:715-829-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty