Provider Demographics
NPI:1952390783
Name:NORTH REACH HEALTHCARE LLC
Entity Type:Organization
Organization Name:NORTH REACH HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:P
Authorized Official - Last Name:HIPKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-732-2075
Mailing Address - Street 1:3120 RIVERSIDE AVE
Mailing Address - Street 2:GATE B BUILDING 1
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1123
Mailing Address - Country:US
Mailing Address - Phone:715-732-2075
Mailing Address - Fax:715-732-2152
Practice Address - Street 1:3120 RIVERSIDE AVE
Practice Address - Street 2:GATE B BUILDING 1
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1123
Practice Address - Country:US
Practice Address - Phone:715-732-2075
Practice Address - Fax:715-732-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 207V00000X, 208000000X
WI52D0710136291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000040160Medicare Oscar/Certification