Lake Area Free Clinic

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

LAKE AREA FREE CLINIC

Practice address

856 B Armour Road
Oconomowoc, WI 50366

Phone

(262) 569-4990

NPI assigned

Apr 21, 2017

Last updated

Apr 21, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Reich

Title

Executive Director

Phone

(262) 569-4990

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Beth Ann Gramz, RDH

  • Dental Hygienist
  • Oconomowoc, WI
  • NPI 1629585021
  NPD (past)

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

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492732800000",
    "number": "1508391079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "856 B ARMOUR ROAD",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "50366",
            "telephone_number": "262-569-4990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "856 B ARMOUR ROAD",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "50366",
            "telephone_number": "262-569-4990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE AREA FREE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-21",
        "last_updated": "2017-04-21",
        "status": "A",
        "authorized_official_last_name": "REICH",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "262-569-4990"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susanc Kuerschner, LPN
• Nicole Anissa Kujawa, PA
• Olivia Jill Kulaszewicz, PHARMD
• Emily Kulpa, PHARMD
• Gerard L. Kupperman, PH.D.
• Lake Country Birth LLC
• Lake Country Classical Academy, Inc.
• Lake Country Dentistry, L.L.C.
• Lake Country Emergency Physicians
• Lake Country Endoscopy Center, LLC

• Voluntary or Charitable Agency in Oconomowoc, WI
• Providers in Oconomowoc, WI by specialty
• Voluntary or Charitable Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; 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.