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Ambulatory Health Care Facilities Clinic/Center Health Service

Provider NPI: 1558547026

Organization Information:
Organization is not Subpart
Authorized Official:  TIMOTHY NEIL JOHNSON  PRESIDENT  920-921-4910

Practice Location:
195 14TH ST  FOND DU LAC, WI 54935-5976 US
Tel: 920-921-4910  Fax: 920-921-8645

Business Mailing Address:
195 14TH ST P.O.BOX 1451 FOND DU LAC, WI 54935-5976 US
Tel: 920-921-4910  Fax: 920-921-8645

NPI Information:
NPI: 1558547026
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Y261QH0100XAmbulatory Health Care Facilities
Health Service

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 261QH0100X





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