| Random Lake Spine & Sports Clinic | |
|
321 Carroll St. Random Lake WI 53075 | |
| (920) 994-2000 | |
| Not Available |
| Full Name | Random Lake Spine & Sports Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 321 Carroll St., Random Lake, Wisconsin |
| Authorized Official Name and Position | Jason C Rudelich (PRESIDENT) |
| Authorized Official Contact | 9209942000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Random Lake Spine & Sports Clinic Po Box 196 Random Lake WI 53075-0196 Ph: (920) 994-2000 | Random Lake Spine & Sports Clinic 321 Carroll St. Random Lake WI 53075 Ph: (920) 994-2000 |
| NPI Number | 1659543205 |
|---|---|
| Provider Enumeration Date | 03/24/2008 |
| Last Update Date | 06/02/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659543205 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Random Lake Medical Center Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: N639 Silver Creek Cascade Road, Random Lake, WI 53075 Phone: 920-994-9999 Fax: 920-994-9998 | |
Prohealth Chiropractic Center S.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 321 Carroll St, Random Lake, WI 53075 Phone: 920-994-2000 |