| Mainstreet Clinic Sc | |
|
1001 Main St W Ashland WI 54806-1307 | |
| (715) 682-5601 | |
| (715) 682-6878 |
| Full Name | Mainstreet Clinic Sc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1001 Main St W, Ashland, Wisconsin |
| Authorized Official Name and Position | Karyl L Dewitt (ADMINISTRATOR) |
| Authorized Official Contact | 7156825601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mainstreet Clinic Sc 1001 Main St W Ashland WI 54806-1307 Ph: (715) 682-5601 | Mainstreet Clinic Sc 1001 Main St W Ashland WI 54806-1307 Ph: (715) 682-5601 |
| NPI Number | 1134137557 |
|---|---|
| Provider Enumeration Date | 08/03/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 0446385918 |
|---|---|
| Medicare Enrollment ID | O20100323000423 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134137557 | NPI | - | NPPES |
| 32852600 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Wisconsin) | Primary |
| Provider Name | Andrew T Matheus |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467460980 PECOS PAC ID: 8123153582 Enrollment ID: I20100324000390 |
| Provider Name | Carrie L Alajoki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215516372 PECOS PAC ID: 9931501236 Enrollment ID: I20210708003086 |
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