NPIMap

Organization Active NPI

Family Care Medical Clinic

  • Family Medicine Physician
  • Marinette, WI
National Provider Identifier
1457528069
Registry record updated May 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FAMILY CARE MEDICAL CLINIC
Practice address
3123 Shore Dr
Suite 202
Marinette, WI 54143-4287
Phone
(715) 732-4120
Fax
(715) 732-4430
NPI assigned
May 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2008

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

Authorized official

Name
Mr. Charles P Quartana
Title
Ceo
Phone
(715) 732-2075

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3123 Shore Dr
Suite 202
Marinette, WI 54143-4287

Mailing address

3123 Shore Dr
Suite 202
Marinette, WI 54143-4287
Phone (715) 732-4120

Other identifiers 1

IdentifierTypeStateIssuer
43060500MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Northreach Healthcare LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

3123 Shore Dr
Ste 202
Marinette, WI 54143
Phone (715) 732-4120

NPI Registry JSON

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210636800000",
    "number": "1457528069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3123 SHORE DR",
            "address_2": "SUITE 202",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541434287",
            "telephone_number": "715-732-4120",
            "fax_number": "715-732-4430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3123 SHORE DR",
            "address_2": "SUITE 202",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541434287",
            "telephone_number": "715-732-4120",
            "fax_number": "715-732-4430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CARE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-13",
        "last_updated": "2008-05-13",
        "status": "A",
        "authorized_official_last_name": "QUARTANA",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "715-732-2075",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43060500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marinette, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.