Grass Roots Health Foods

Primary specialty

Medical Foods SupplierTaxonomy code 335G00000X

Legal business name

GRASS ROOTS HEALTH FOODS

Practice address

3440 State Highway 70 E
Eagle River, WI 54521-9491

Phone

(715) 479-6299

NPI assigned

Jan 5, 2012

Last updated

Jul 21, 2022By 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

Mr. David G. Koller

Title

Owner

Phone

(715) 479-6299

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1679843700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3440 STATE HIGHWAY 70 E",
            "city": "EAGLE RIVER",
            "state": "WI",
            "postal_code": "545219491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3440 STATE HIGHWAY 70 E",
            "city": "EAGLE RIVER",
            "state": "WI",
            "postal_code": "545219491",
            "telephone_number": "715-479-6299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRASS ROOTS HEALTH FOODS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KOLLER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-479-6299",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335G00000X",
            "taxonomy_group": "",
            "desc": "Medical Foods Supplier",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Foods Supplier in Eagle River, WI
• Providers in Eagle River, WI by specialty
• Medical Foods Supplier in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.