Primary Connection Healthcare, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

PENDING Issued in WI

Legal business name

PRIMARY CONNECTION HEALTHCARE, INC.

Practice address

1810 2ND St
Wausau, WI 54403-3492

Phone

(715) 848-4884

Fax

(715) 845-5385

NPI assigned

Jul 23, 2009

Organization subpart

Yes

Parent organization

PRIMARY CONNECTION HEALTHCARE, INC.As reported in NPPES

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

Authorized official

Name

Ms. Laura Scudiere

Title

Executive Director

Phone

(715) 848-4884

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Bridge Community Health Clinic Mental Health Services Doing business as

Tax ID family

Primary Connection Heal2 organizations share this tax ID, including this one

Part of

Primary Connection Heal

Other organizations with this tax ID 1

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

• Primary Connection Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Merrill, WI
  • NPI 1265723688
  NPD tax ID

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

{
    "created_epoch": "1248307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248307200000",
    "number": "1285864389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 2ND ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544033492",
            "telephone_number": "715-848-4884",
            "fax_number": "715-845-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 2ND ST",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544033492",
            "telephone_number": "715-848-4884",
            "fax_number": "715-845-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CONNECTION HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CONNECTION HEALTHCARE, INC.",
        "enumeration_date": "2009-07-23",
        "last_updated": "2009-07-23",
        "status": "A",
        "authorized_official_last_name": "SCUDIERE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "715-848-4884",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OUTPATIENT MENTAL HEALTH CLINIC CERTIFICATION NUMBER",
            "identifier": "PENDING",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridge Community Health Clinic Mental Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Joseph J Prillwitz, LPC
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• Karen T. Prochaska, LPC-SAS
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• Brian Damien Puent, MS OD

• Community/Behavioral Health Agency in Wausau, WI
• Providers in Wausau, WI by specialty
• Community/Behavioral Health Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2009; 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.