NPIMap

Organization Active NPI

Cesa #11 Rural Health Dental Clinic

  • Dental Clinic/Center
  • Menomonie, WI
National Provider Identifier
1730390840
Registry record updated Aug 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
CESA #11 RURAL HEALTH DENTAL CLINIC
Practice address
3375 Kothlow Ave.
Suite 40
Menomonie, WI 54751
Phone
(715) 235-1573
Fax
(715) 235-2081
NPI assigned
May 24, 2007
Last updated
Aug 6, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2008

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

Authorized official

Name
Ms. Sharon Haugerud
Title
Director
Phone
(715) 986-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X WI Primary

Addresses

Primary practice location

3375 Kothlow Ave.
Suite 40
Menomonie, WI 54751

Mailing address

225 Ostermann Dr
Turtle Lake, WI 54889-9191
Phone (715) 986-2020

Other identifiers 1

IdentifierTypeStateIssuer
38389000MedicaidWI

National Provider Directory

National Provider Directory
Tax ID family
Cesa 11 Rural Health Dental Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

3375 Kothlow Ave
Ste 40
Menomonie, WI 54751
Phone (715) 235-1573

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217980800000",
    "number": "1730390840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 OSTERMANN DR",
            "city": "TURTLE LAKE",
            "state": "WI",
            "postal_code": "548899191",
            "telephone_number": "715-986-2020",
            "fax_number": "715-986-2041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3375 KOTHLOW AVE.",
            "address_2": "SUITE 40",
            "city": "MENOMONIE",
            "state": "WI",
            "postal_code": "54751",
            "telephone_number": "715-235-1573",
            "fax_number": "715-235-2081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CESA #11 RURAL HEALTH DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2008-08-06",
        "status": "A",
        "authorized_official_last_name": "HAUGERUD",
        "authorized_official_first_name": "SHARON",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "715-986-2020",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38389000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Menomonie, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.