| Wolfe Mobile Medical Llc | |
|
510 Grey Fox Run Watertown WI 53094-5901 | |
| (920) 253-5851 | |
| Not Available |
| Full Name | Wolfe Mobile Medical Llc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 510 Grey Fox Run, Watertown, Wisconsin |
| Authorized Official Name and Position | Thomas Andrew Wolfe (MEMBER) |
| Authorized Official Contact | 9202535851 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wolfe Mobile Medical Llc 510 Grey Fox Run Watertown WI 53094-5901 Ph: (920) 253-5851 | Wolfe Mobile Medical Llc 510 Grey Fox Run Watertown WI 53094-5901 Ph: (920) 253-5851 |
| NPI Number | 1265611586 |
|---|---|
| Provider Enumeration Date | 11/02/2007 |
| Last Update Date | 11/02/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265611586 | NPI | - | NPPES |
| 1003998394 | Other | NPI ENUMERATOR | |
| 31425500 | Medicaid | WI | |
| 29319 | Other | WI | WI, DEPT REGULATION & LIS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 29319-020 (Wisconsin) | Primary |
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