MGM-Eastview

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5265 Issued in WI

Legal business name

MGM-EASTVIEW

Practice address

729 Park St
Antigo, WI 54409-2745

Phone

(715) 623-2356

NPI assigned

May 5, 2016

Last updated

May 5, 2016By 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

Tina Brandt

Title

Rehab Tech

Phone

(715) 623-2356

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1462406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462406400000",
    "number": "1780030064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 219",
            "address_2": "340A MAIN STREET",
            "city": "BIRNAMWOOD",
            "state": "WI",
            "postal_code": "544140219",
            "telephone_number": "920-606-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "729 PARK ST",
            "city": "ANTIGO",
            "state": "WI",
            "postal_code": "544092745",
            "telephone_number": "715-623-2356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MGM-EASTVIEW",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-05",
        "last_updated": "2016-05-05",
        "status": "A",
        "authorized_official_last_name": "BRANDT",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "REHAB TECH",
        "authorized_official_telephone_number": "715-623-2356"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "5265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol L. McDougal, SLP
• Dennis S McFadden, DO
• Thomas E McGrath, LPC
• Julie A Meehan, P.T.A.
• James P. Meinert, P.T.
• Midline Vision Group LLC
• Cami Lee Miller, PTA
• Melissa Ann Miller, PTA
• Rachael Elizabeth Miller
• Michael S Moore, MD

• Skilled Nursing Facility in Antigo, WI
• Providers in Antigo, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2016; 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.