| Beta One Health Llc | |
|
7200 Washington Ave Ste 107 Mt Pleasant WI 53406-6516 | |
| (262) 622-6264 | |
| (262) 632-0379 |
| Full Name | Beta One Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7200 Washington Ave Ste 107, Mt Pleasant, Wisconsin |
| Authorized Official Name and Position | Tom Constantin Tousis (AUTHORIZED REPRESENTATIVE) |
| Authorized Official Contact | 2626226264 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beta One Health Llc 7200 Washington Ave Ste 107 Mt Pleasant WI 53406-6516 Ph: (262) 622-6264 | Beta One Health Llc 7200 Washington Ave Ste 107 Mt Pleasant WI 53406-6516 Ph: (262) 622-6264 |
| NPI Number | 1386380301 |
|---|---|
| Provider Enumeration Date | 05/11/2022 |
| Last Update Date | 05/12/2022 |
| Medicare PECOS PAC ID | 1355707720 |
|---|---|
| Medicare Enrollment ID | O20230510002495 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386380301 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Ginger Renee Bland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205451564 PECOS PAC ID: 1254757297 Enrollment ID: I20200820002042 |
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