Provider Demographics
NPI:1740263326
Name:CITY OF EAU CLAIRE
Entity type:Organization
Organization Name:CITY OF EAU CLAIRE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:715-839-4718
Mailing Address - Street 1:720 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-5413
Mailing Address - Country:US
Mailing Address - Phone:715-839-4718
Mailing Address - Fax:715-839-1674
Practice Address - Street 1:720 2ND AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5413
Practice Address - Country:US
Practice Address - Phone:715-839-4718
Practice Address - Fax:715-839-1674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43080600Medicaid
WI44000200Medicaid
WI41852400Medicaid
WI42007200Medicaid
WI44000200Medicaid