NPIMap

Organization Active NPI

Crivitz Medical Center

  • Family Medicine Physician
  • Crivitz, WI
National Provider Identifier
1548437155
Registry record updated May 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CRIVITZ MEDICAL CENTER
Practice address
213 S Hwy 141
Crivitz, WI 54114
Phone
(715) 732-2075
Fax
(715) 732-2072
NPI assigned
May 13, 2008
Last updated
May 13, 2008By the provider in NPPES
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 Physician 207Q00000X NU Primary

Addresses

Primary practice location

213 S Hwy 141
Crivitz, WI 54114

Mailing address

218 S Hwy 141
Crivitz, WI 54114-1677
Phone (715) 854-7477

Other identifiers 1

IdentifierTypeStateIssuer
43060400MedicaidWI

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.

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": "1548437155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 S HWY 141",
            "city": "CRIVITZ",
            "state": "WI",
            "postal_code": "541141677",
            "telephone_number": "715-854-7477",
            "fax_number": "715-854-7785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 S HWY 141",
            "city": "CRIVITZ",
            "state": "WI",
            "postal_code": "54114",
            "telephone_number": "715-732-2075",
            "fax_number": "715-732-2072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRIVITZ MEDICAL CENTER",
        "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": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43060400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crivitz, 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.