Park Hill Clinic, SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PARK HILL CLINIC, SC

Practice address

111 Anna St
Waterloo, WI 53594-1184

Phone

(920) 478-3776

Fax

(920) 478-3979

NPI assigned

Jul 16, 2006

Organization subpart

No

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

Authorized official

Name

Marlys Schmidt

Title

Cco

Phone

(920) 478-3776

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1760409536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 ANNA ST",
            "city": "WATERLOO",
            "state": "WI",
            "postal_code": "535941184",
            "telephone_number": "920-478-3776",
            "fax_number": "920-478-3979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 ANNA ST",
            "city": "WATERLOO",
            "state": "WI",
            "postal_code": "535941184",
            "telephone_number": "920-478-3776",
            "fax_number": "920-478-3979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK HILL CLINIC, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHMIDT",
        "authorized_official_first_name": "MARLYS",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "920-478-3776"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH CARE PCP #",
            "identifier": "P37",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anne Leclaire-Thoma, RN
• David M Martin, AA-C
• Emily R Marty, SLP
• Jennifer Rose McKay Sillman, LPC
• F. Bradford Meyers, M.D.
• Russel Raymond Peloquin, RN
• Dino Pitta
• Julee R Radtke, NP
• Tyler George Schneekloth, D.C.
• Laura B Schultz, PA-C

• Family Medicine Physician in Waterloo, WI
• Providers in Waterloo, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.