NPIMap

Organization Active NPI

North Central Region CCS Program

  • Community/Behavioral Health Agency
  • Medford, WI
National Provider Identifier
1043727936
Registry record updated Jan 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
3193 Issued in WI
Legal business name
NORTH CENTRAL REGION CCS PROGRAM
Practice address
540 College St
Medford, WI 54451-2027
Phone
(715) 748-3332
Fax
(715) 748-3342
NPI assigned
Jan 2, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rhonda Rudolph
Title
Business Manager
Phone
(715) 748-3332

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 3193 WI Primary

Addresses

Primary practice location

540 College St
Medford, WI 54451-2027

Mailing address

540 College St
Medford, WI 54451-2027
Phone (715) 748-3332

Other identifiers 1

IdentifierTypeStateIssuer
42140500MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Taylor Cty Nurs Serv9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1514851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516060800000",
    "number": "1043727936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 COLLEGE ST",
            "city": "MEDFORD",
            "state": "WI",
            "postal_code": "544512027",
            "telephone_number": "715-748-3332",
            "fax_number": "715-748-3342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 COLLEGE ST",
            "city": "MEDFORD",
            "state": "WI",
            "postal_code": "544512027",
            "telephone_number": "715-748-3332",
            "fax_number": "715-748-3342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH CENTRAL REGION CCS PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-02",
        "last_updated": "2018-01-16",
        "status": "A",
        "authorized_official_last_name": "RUDOLPH",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "715-748-3332"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "3193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42140500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.