NPIMap

Organization Active NPI

Northreach Healthcare, LLC

Doing business as Northreach Pediatrics

  • Pediatrics Physician
  • Marinette, WI
National Provider Identifier
1861539140
Registry record updated Mar 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
NORTHREACH HEALTHCARE, LLC
Doing business as
Northreach Pediatrics
Practice address
1106 University Dr
Marinette, WI 54143-5110
Phone
(715) 735-5272
Fax
(715) 735-0895
NPI assigned
Jan 30, 2007
Last updated
Mar 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2013

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

Authorized official

Name
Carol Hipke
Title
Director of Business Services
Phone
(715) 732-2078

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

1106 University Dr
Marinette, WI 54143-5110

Mailing address

3120 Riverside Ave
Gate B Building 1
Marinette, WI 54143-1123
Phone (715) 732-2075

Other identifiers 1

IdentifierTypeStateIssuer
21278200MedicaidWI

Other names 1

  • Northreach Pediatrics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Northreach Healthcare LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

1106 University Dr
Marinette, WI 54143
Phone (715) 732-0832

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364428800000",
    "number": "1861539140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 RIVERSIDE AVE",
            "address_2": "GATE B BUILDING 1",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541431123",
            "telephone_number": "715-732-2075",
            "fax_number": "715-732-2072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 UNIVERSITY DR",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541435110",
            "telephone_number": "715-735-5272",
            "fax_number": "715-735-0895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHREACH HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2013-03-28",
        "status": "A",
        "authorized_official_last_name": "HIPKE",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS SERVICES",
        "authorized_official_telephone_number": "715-732-2078"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21278200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northreach Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marinette, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2013; 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.