| Spectrum Health Medical Clinic, Llc | |
|
W176n9830 Rivercrest Dr Suite 102 Germantown WI 53022-4625 | |
| (414) 324-0944 | |
| (414) 921-5600 |
| Full Name | Spectrum Health Medical Clinic, Llc |
|---|---|
| Speciality | General Practice |
| Location | W176n9830 Rivercrest Dr, Germantown, Wisconsin |
| Authorized Official Name and Position | Joseph Alan Locke (PRESIDENT/OWNER) |
| Authorized Official Contact | 4143240944 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectrum Health Medical Clinic, Llc Po Box 639 Thiensville WI 53092-0639 Ph: (414) 247-9005 | Spectrum Health Medical Clinic, Llc W176n9830 Rivercrest Dr Suite 102 Germantown WI 53022-4625 Ph: (414) 324-0944 |
| NPI Number | 1477981942 |
|---|---|
| Provider Enumeration Date | 10/21/2013 |
| Last Update Date | 03/13/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477981942 | NPI | - | NPPES |
| K100107570 | Other | WI | MEDICARE PTAN |
| 1902078801 | Other | NPI INDIVIDUAL | |
| K400107593 | Other | MEDICARE PTAN INDIVIDUAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 53594 (Wisconsin) | Primary |
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