| North Central Region Ccs Program | |
|
540 College St Medford WI 54451-2027 | |
| (715) 748-3332 | |
| (715) 748-3342 |
| Full Name | North Central Region Ccs Program |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 540 College St, Medford, Wisconsin |
| Authorized Official Name and Position | Rhonda Rudolph (BUSINESS MANAGER) |
| Authorized Official Contact | 7157483332 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| North Central Region Ccs Program 540 College St Medford WI 54451-2027 Ph: (715) 748-3332 | North Central Region Ccs Program 540 College St Medford WI 54451-2027 Ph: (715) 748-3332 |
| NPI Number | 1043727936 |
|---|---|
| Provider Enumeration Date | 01/02/2018 |
| Last Update Date | 01/16/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043727936 | NPI | - | NPPES |
| 42140500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 3193 (Wisconsin) | Primary |
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