Green Lake Medical Clinic

LBN: Green Lake Medical Clinic
Green Lake Medical Clinic is an health care organization with primary practice located at N6205 Busse Drive , Green Lake WI 54941-0429. The organization recently has only one registered license in Laboratories / Clinical Medical Laboratory, which is considered as the primary health care specialty. Green Lake Medical Clinic can be contacted via phone (920) 294-3444, or through Willett, Thomas Rice via phone (920) 294-3444.

Contact Information

Primary practice address
N6205 Busse Drive Green Lake WI 54941-0429
Phone: (920) 294-3444
Fax: (920) 294-6660
Website:
Map and Directions
Authorized official contact:
Name: Willett, Thomas Rice Doctor of Osteopathy (DO)
Phone: (920) 294-3444

Health care specialties

SpecialtyCodeLicense #State
Laboratories / Clinical Medical Laboratory 291U00000X 17659 Wisconsin

Profile Details

NPI number 1316087885
LBN Legal business name Green Lake Medical Clinic
DBA Doing business as
Authorized official Willett, Thomas Rice Doctor of Osteopathy (DO)
Entity Organization
Organization subpart 1 No
Enumeration date Feb 7th, 2007
Last updated Aug 22nd, 2020 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316087885 NPPES
Wisconsin MEDICAID 30071600

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