NPIMap

Organization Active NPI

Clark County

  • Public Health or Welfare Agency
  • Neillsville, WI
National Provider Identifier
1679617831
Registry record updated Apr 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
CLARK COUNTY
Practice address
517 Court St
Room #105
Neillsville, WI 54456-1971
Phone
(715) 743-5105
NPI assigned
Feb 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2013

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

Authorized official

Name
Robert J Leischow, MPH
Title
Director
Phone
(715) 743-5116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X Primary

Addresses

Primary practice location

517 Court St
Room #105
Neillsville, WI 54456-1971

Mailing address

517 Court St
Room #105
Neillsville, WI 54456-1971
Phone (715) 743-5105

Other identifiers 3

IdentifierTypeStateIssuer
44011000MedicaidWI
42006800MedicaidWI
41851500MedicaidWI

Other names 1

  • Clark County Public Health Department Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090304000429 WI Part B Supplier - Mass Immunization (Roster Biller Only) 3476464843 Practice locations: Neillsville, WI

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Clark County Health Dep6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

517 Court St
Rm 105
Neillsville, WI 54456
Phone (715) 743-5105

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Woodland Enhanced Health ServicesOwen, WI, CCN 525403 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366848000000",
    "number": "1679617831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 COURT ST",
            "address_2": "ROOM #105",
            "city": "NEILLSVILLE",
            "state": "WI",
            "postal_code": "544561971",
            "telephone_number": "715-743-5105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 COURT ST",
            "address_2": "ROOM #105",
            "city": "NEILLSVILLE",
            "state": "WI",
            "postal_code": "544561971",
            "telephone_number": "715-743-5105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-19",
        "last_updated": "2013-04-25",
        "status": "A",
        "authorized_official_last_name": "LEISCHOW",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "715-743-5116",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44011000",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42006800",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41851500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clark County Public Health Department",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Neillsville, WI

Sources for this page

Verify at the official NPI Registry.