| Spencer Tasch Clinic, Inc | |
|
800 Wisconsin St Ste 420 Eau Claire WI 54703-3588 | |
| (715) 210-9284 | |
| Not Available |
| Full Name | Spencer Tasch Clinic, Inc |
|---|---|
| Speciality | Counselor |
| Location | 800 Wisconsin St Ste 420, Eau Claire, Wisconsin |
| Authorized Official Name and Position | Brita Spencer (OWNER) |
| Authorized Official Contact | 7152109284 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spencer Tasch Clinic, Inc 800 Wisconsin St Ste 420 Eau Claire WI 54703-3588 Ph: (715) 210-9284 | Spencer Tasch Clinic, Inc 800 Wisconsin St Ste 420 Eau Claire WI 54703-3588 Ph: (715) 210-9284 |
| NPI Number | 1285134858 |
|---|---|
| Provider Enumeration Date | 02/20/2018 |
| Last Update Date | 04/02/2018 |
| Medicare PECOS PAC ID | 0042572232 |
|---|---|
| Medicare Enrollment ID | O20180328001727 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285134858 | NPI | - | NPPES |
| 1467985507 | Medicaid | WI | |
| 1508305269 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 1231-125 (Wisconsin) | Primary |
| 101Y00000X | Counselor | 130012-121 (Wisconsin) | Secondary |
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