| Divine Savior Healthcare, Inc. | |
|
N4390 Crossroads Clinic Road Oxford WI 53952 | |
| (608) 589-5333 | |
| (608) 742-6098 |
| Full Name | Divine Savior Healthcare, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | N4390 Crossroads Clinic Road, Oxford, Wisconsin |
| Authorized Official Name and Position | Jerry M Yang (SVP & CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7158472526 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Divine Savior Healthcare, Inc. 29980 Network Pl Chicago IL 60673-1299 Ph: (715) 847-2304 | Divine Savior Healthcare, Inc. N4390 Crossroads Clinic Road Oxford WI 53952 Ph: (608) 589-5333 |
| NPI Number | 1942712344 |
|---|---|
| Provider Enumeration Date | 10/26/2017 |
| Last Update Date | 06/14/2024 |
| Medicare PECOS PAC ID | 5799684007 |
|---|---|
| Medicare Enrollment ID | O20171220000762 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942712344 | NPI | - | NPPES |
| 32767300 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (Wisconsin) | Primary |