Douglas B Moericke, PA
Individual provider Active NPI Medical Physician Assistant · Whitehall, WI
NPI 1366446841 · NPPES record last updated Mar 19, 2019
Key facts
- NPI
- 1366446841
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 492 (WI)
- Practice address
- 18601 Lincoln St
Whitehall, WI 54773-8605 - Phone
- (715) 538-4361
- NPI assigned
- Jun 13, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 492 | WI | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-County Memorial Hospital, Inc. | Current |
Accepting new patients | |
| County of Trempealeau | Current |
Accepting new patients | |
| County of Trempealeau | Current |
Accepting new patients | |
| Gundersen Clinic LTD | Past | Accepting new patients |
Locations
18601 Lincoln St
Whitehall, WI 54773
Phone (715) 538-1712
W20410 State Road 121
Whitehall, WI 54773
Phone (715) 538-4312
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 492 | WI | Yes |
Addresses
Primary practice location
18601 Lincoln St
Whitehall, WI 54773-8605
Mailing address
18601 Lincoln St
Whitehall, WI 54773-8605
Phone (715) 538-1712
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42940400 | Medicaid | WI |
Other providers in Whitehall, WI
- Kimberley Lenning
- Caitlin Marie Luttropp
- Jeffrey J. Matthews
- Paul Maulucci
- Julie J Meyers
- Kelly Isabel Mohr
- Tanya Mudgett
- Mary C Nilsson
- Angel May Olson
- Tracey Lynn Olson
All providers in Whitehall, WI · Medical Physician Assistant in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2019. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.