| Northlakes Community Clinic | |
|
11128 N State Road 77 Hayward WI 54843-5332 | |
| (715) 634-2541 | |
| (715) 634-5740 |
| Full Name | Northlakes Community Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 11128 N State Road 77, Hayward, Wisconsin |
| Authorized Official Name and Position | Reba Rice (CEO) |
| Authorized Official Contact | 7153725001 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northlakes Community Clinic 15735 W Us Highway 63 Hayward WI 54843-6475 Ph: (715) 934-0710 | Northlakes Community Clinic 11128 N State Road 77 Hayward WI 54843-5332 Ph: (715) 634-2541 |
| NPI Number | 1144298787 |
|---|---|
| Provider Enumeration Date | 03/09/2006 |
| Last Update Date | 08/05/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144298787 | NPI | - | NPPES |
| 1811178825 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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