Provider Demographics
NPI:1750579454
Name:COUNTY OF DUNN
Entity type:Organization
Organization Name:COUNTY OF DUNN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:D
Authorized Official - Last Name:DIERICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-231-2771
Mailing Address - Street 1:3001 US HIGHWAY 12 E STE 225
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-3045
Mailing Address - Country:US
Mailing Address - Phone:715-232-2771
Mailing Address - Fax:715-232-5987
Practice Address - Street 1:3001 US HIGHWAY 12 E STE 160
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-3045
Practice Address - Country:US
Practice Address - Phone:715-232-1116
Practice Address - Fax:715-232-5987
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF DUNN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43071900Medicaid
WI60011400OtherWI MA TRADING PARTNER ID