NPIMap

Organization Active NPI

Roche a Cri Clinic SC

  • Family Medicine Physician
  • Friendship, WI
National Provider Identifier
1336173095
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ROCHE A CRI CLINIC SC
Practice address
302 W. Lake St.
Friendship, WI 53934
Phone
(608) 339-3326
Fax
(608) 339-6057
NPI assigned
Jul 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Ms. Marlene Wahlen
Title
Office Manager
Phone
(609) 339-3326

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X WI Primary

Addresses

Primary practice location

302 W. Lake St.
Friendship, WI 53934

Mailing address

P.O. Box 10
Friendship, WI 53934-0010
Phone (608) 339-3326

Other identifiers 2

IdentifierTypeStateIssuer
32742100MedicaidWI
43055000MedicaidWI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1336173095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 10",
            "city": "FRIENDSHIP",
            "state": "WI",
            "postal_code": "539340010",
            "telephone_number": "608-339-3326",
            "fax_number": "608-339-6057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W. LAKE ST.",
            "city": "FRIENDSHIP",
            "state": "WI",
            "postal_code": "53934",
            "telephone_number": "608-339-3326",
            "fax_number": "608-339-6057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCHE A CRI CLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WAHLEN",
        "authorized_official_first_name": "MARLENE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "609-339-3326",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32742100",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43055000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Friendship, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.