Provider Demographics
NPI:1982096772
Name:OAKLEAF CLINICS INC
Entity Type:Organization
Organization Name:OAKLEAF CLINICS INC
Other - Org Name:OAKLEAF CLINICS, OAKLEAF PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:LONGBELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-836-9242
Mailing Address - Street 1:719 W HAMILTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6970
Mailing Address - Country:US
Mailing Address - Phone:715-552-9784
Mailing Address - Fax:715-835-6370
Practice Address - Street 1:3213 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6946
Practice Address - Country:US
Practice Address - Phone:715-830-0732
Practice Address - Fax:715-830-5487
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKLEAF CLINICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-03
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty