Provider Demographics
NPI:1932218187
Name:HSHS WISCONSIN MEDICAL GROUP INC
Entity Type:Organization
Organization Name:HSHS WISCONSIN MEDICAL GROUP INC
Other - Org Name:FAMILY HEALTH ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUTTERTIO
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:715-723-9138
Mailing Address - Street 1:2509 COUNTY HIGHWAY I
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1422
Mailing Address - Country:US
Mailing Address - Phone:715-723-9138
Mailing Address - Fax:
Practice Address - Street 1:2509 COUNTY HIGHWAY I
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1422
Practice Address - Country:US
Practice Address - Phone:715-723-9138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000011030OtherMEDICARE
WI1245233287OtherNPI NUMBER KRISTIE GERING
1386609915OtherNPI STEVEN STEINMETZ
WI1730182809OtherNPI NUMBER PAUL IPPEL
WI32803100Medicaid
WI1861495913OtherNPI NUMBER ROBERT LEA
WI1235144031OtherNPI NUMBER JILL HASENBERG