Bouc Family Wellness Center, LLC
Organization Active NPI Family Medicine Physician · Beloit, WI
NPI 1356520563 · NPPES record last updated Apr 26, 2018
Key facts
- NPI
- 1356520563
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 36893 (WI)
- Legal business name
- BOUC FAMILY WELLNESS CENTER, LLC
- Practice address
- 3005 Riverside Dr
Suite 101
Beloit, WI 53511-1500 - Phone
- (608) 365-7200
- Fax
- (608) 365-7202
- NPI assigned
- Oct 24, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Geoffrey T Bouc, M.D.
- Title
- Physician
- Phone
- (608) 365-7200
Practitioners 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041025000374 | WI | Part B Supplier - Clinic/Group Practice | 9032170857 |
Receives reassigned benefits from 2 practitioners Practice locations: Beloit, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 36893 | WI | Yes |
Addresses
Primary practice location
3005 Riverside Dr
Suite 101
Beloit, WI 53511-1500
Mailing address
3005 Riverside Dr
Suite 101
Beloit, WI 53511-1500
Phone (608) 365-7200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32161500 | Medicaid | WI |
Other providers in Beloit, WI
- David Andrew Block
- Brittany Noel Rowe Blomberg
- John Works Boardman
- Loria R. Boone
- Nathaniel S Bothfeld
- Geoffrey Thomas Bouc
- Peter Zenithen Bouc
- Erika Leigh Bourdeaux
- Susan G Bower
- Kate E Bowgren
All providers in Beloit, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 26, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.