NPIMap

Organization Active NPI

CMH Mountain Primary Care Clinic

Doing business as Douglas C Gremban MD

  • Non-Pharmacy Dispensing Site
  • Mountain, WI
National Provider Identifier
1407801236
Registry record updated Mar 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
23967020 Issued in WI
Legal business name
CMH MOUNTAIN PRIMARY CARE CLINIC
Doing business as
Douglas C Gremban MD
Practice address
13435 Weller Rd
Mountain, WI 54149-9482
Phone
(715) 276-1600
Fax
(715) 276-1800
NPI assigned
May 23, 2006
Last updated
Mar 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2008

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

Authorized official

Name
Greg Henn
Title
Clinic Manager
Phone
(920) 846-3440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X 23967020 WI Primary

Addresses

Primary practice location

13435 Weller Rd
Mountain, WI 54149-9482

Mailing address

855 S Main St
Oconto Falls, WI 54154-1241

Other identifiers 3

IdentifierTypeStateIssuer
31756500MedicaidWI
5128904OtherOTHER ID NUMBER
5128904OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • DOUGLAS C GREMBAN MD Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Clare Memorial Hospital16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

13435 Weller Rd
Mountain, WI 54149
Phone (715) 276-1600

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205280000000",
    "number": "1407801236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 S MAIN ST",
            "city": "OCONTO FALLS",
            "state": "WI",
            "postal_code": "541541241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13435 WELLER RD",
            "city": "MOUNTAIN",
            "state": "WI",
            "postal_code": "541499482",
            "telephone_number": "715-276-1600",
            "fax_number": "715-276-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMH MOUNTAIN PRIMARY CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2008-03-12",
        "status": "A",
        "authorized_official_last_name": "HENN",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "920-846-3440"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "WI",
            "license": "23967020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31756500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER",
            "identifier": "5128904",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "5128904",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DOUGLAS C GREMBAN MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; 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.