Columbia Correctional Institution
Organization Active NPI Clinic/Center · Portage, WI
NPI 1760522452 · NPPES record last updated May 23, 2008
Key facts
- NPI
- 1760522452
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- License
- 28096 (WI)
- Legal business name
- COLUMBIA CORRECTIONAL INSTITUTION
- Practice address
- 2925 Columbia Dr
Portage, WI 53901-9485 - Phone
- (608) 742-9100
- NPI assigned
- Feb 8, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Dalia Suliene, MD
- Title
- Physician
- Phone
- (608) 742-9100
Practitioners 2
-
Kelsey Stange, PSY.D.
-
Dalia Suliene, MD
National Provider Directory
Locations
2925 Columbia Dr
Portage, WI 53901
Phone (608) 742-9100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | 28096 | WI | Yes |
Addresses
Primary practice location
2925 Columbia Dr
Portage, WI 53901-9485
Mailing address
2925 Columbia Dr
Portage, WI 53901-9485
Other names
- CCI
Other providers in Portage, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.