Basic Information
Provider Information
NPI: 1427642255
EntityType: 2
ReplacementNPI:  
OrganizationName: MCHS HOSPITALS INC
LastName:  
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Credential:  
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Mailing Information
Address1: 1000 N OAK AVE
Address2:  
City: MARSHFIELD
State: WI
PostalCode: 544495703
CountryCode: US
TelephoneNumber: 7153875211
FaxNumber:  
Practice Location
Address1: 1000 N OAK AVE
Address2:  
City: MARSHFIELD
State: WI
PostalCode: 544495703
CountryCode: US
TelephoneNumber: 7153875511
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/23/2021
LastUpdateDate: 02/23/2021
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: EDWARDS
AuthorizedOfficialFirstName: GORDON
AuthorizedOfficialMiddleName: T
AuthorizedOfficialTitleorPosition: CFO/COO
AuthorizedOfficialTelephone: 7153875823
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: MARSHFIELD CLINIC HEALTH SYSTEM INC
AuthorizedOfficialNamePrefix:  
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AuthorizedOfficialCredential:  
NPICertificationDate: 02/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261Q00000X  Y Ambulatory Health Care FacilitiesClinic/Center 

No ID Information.


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