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Ambulatory Health Care Facilities Clinic/Center Multi-Specialty

Provider NPI: 1780169292

Organization Information:
Organization is Subpart
Authorized Official:  ERIKA  LEWIS  ADMIN  800-341-8598

Practice Location:
61440 ARGO RD  MASON, WI 54856-1094 US
Tel: 800-341-8598  Fax: --

Business Mailing Address:
216 TOWER RD  SAN ANTONIO, TX 78223-6018 US
Tel: 800-341-8598  Fax: --

NPI Information:
NPI: 1780169292
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Y261QM1300XAmbulatory Health Care Facilities

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 261QM1300X





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