Provider Demographics
NPI:1881740975
Name:THIENSVILLE FAMILY HEALTH CARE SC
Entity type:Organization
Organization Name:THIENSVILLE FAMILY HEALTH CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-242-3369
Mailing Address - Street 1:140 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1956
Mailing Address - Country:US
Mailing Address - Phone:262-242-3369
Mailing Address - Fax:262-242-3219
Practice Address - Street 1:140 S MAIN ST
Practice Address - Street 2:
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1956
Practice Address - Country:US
Practice Address - Phone:262-242-3369
Practice Address - Fax:262-242-3219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF28913Medicare UPIN