Green Lake Medical Clinic in Green Lake - Clinical Medical Laboratory
Green Lake Medical Clinic - NPI 1316087885
Green Lake Medical Clinic is a Clinical Medical Laboratory in Green Lake, Wisconsin. Green Lake Medical Clinic practices all healthcare services and medical treatments related to Clinical Medical Laboratory. The NPI Number for Green Lake Medical Clinic is 1316087885. The last update date is 2020-08-22.
Green Lake Medical Clinic's current location address is Po Box 429, Green Lake, Wisconsin. You can contact this provider via phone number 9202943444 and fax number 9202946660. The mailing address for Green Lake Medical Clinic is Po Box 429, Green Lake, Wisconsin. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Green Lake Medical Clinic |
|---|---|
| Address | Po Box 429, Green Lake, Wisconsin |
| Phone Number | 9202943444 |
| Fax Number | 9202946660 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | PRESIDENT |
|---|---|
| Authorized Official Name | Willett Rice Thomas |
| Credentials | D.O. |
| Telephone Number | 9202943444 |
NPI Number Detail
| NPI Number | 1316087885 |
|---|---|
| Provider Enumeration Date | 2007-02-07 |
| Last Updated Date | 2020-08-22 |
Provider Mailing Address Detail
| Address | Po Box 429 |
|---|---|
| City | Green Lake |
| State | Wisconsin (WI) |
| Post Code | 549410429 |
| Phone Number | 9202943444 |
| Fax Number | 9202946660 |
Provider's Primary Taxonomy Detail
| Speciality | Clinical Medical Laboratory |
|---|---|
| Taxonomy | 291U00000X |
| Licence No | 17659 |
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Definition: (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purp |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 30071600 | WI | -- |
Post Comment/ Review Below
What is the unique provider identifier assigned to Green Lake Medical Clinic?
The Green Lake Medical Clinic has been issued the NPI (National Provider Identifier) 1316087885 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code is a unique identification number for healthcare providers.
Where is the Green Lake Medical Clinic located?
The Green Lake Medical Clinic is located at Po Box 429, Green Lake, WI 549410429.
What is Green Lake Medical Clinic's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Green Lake Medical Clinic is Clinical Medical Laboratory, and the taxonomy classification code that categorizes this area of expertise is 291U00000X.
When did Green Lake Medical Clinic receive its 1316087885 assignment?
The Green Lake Medical Clinic was assigned its 1316087885 on 2007-02-07, which is the date when this unique identifier was issued to the organization.
As of what date were the Green Lake Medical Clinic's details last updated?
The information pertaining to the Green Lake Medical Clinic, including its address, specialty, and other details, was most recently updated on 2020-08-22.
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