CMH Primary Care Clinic Moutain-Physician Dispensary
Organization Active NPI Family Medicine Physician · Mountain, WI
NPI 1962533455 · NPPES record last updated Dec 23, 2021
Key facts
- NPI
- 1962533455
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 23967-020 (WI)
- Legal business name
- CMH PRIMARY CARE CLINIC MOUTAIN-PHYSICIAN DISPENSARY
- Practice address
- 14353 Hwy 32 & 64
Mountain, WI 54149 - Phone
- (715) 276-1600
- Fax
- (715) 276-1800
- NPI assigned
- Mar 8, 2007
- Organization subpart
- No
Authorized official
- Name
- Douglas C Gremban II, M.D.
- Title
- Physician Dispensary
- Phone
- (715) 276-1600
Corporate family (same tax ID) 15
National Provider Directory
- Tax ID family
- Community Memorial Hospital Incorporated
Locations
14353 State Highway 32 64
Mountain, WI 54149
Phone (715) 276-1600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 23967-020 | WI | Yes |
Addresses
Primary practice location
14353 Hwy 32 & 64
Mountain, WI 54149
Mailing address
14353 Hwy 32 & 64
Mountain, WI 54149
Phone (715) 276-1600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5128904 | Other | WI | NCPDP |
| 395585708005 | Other | WI | GREMBAN BC |
| 31756500 | Medicaid | WI |
Other names
- CMH Primary Care Clinic-Mountain
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | community_memorial_hospital_transitions_of_care2201223@ewd.direct.hshs.org | Direct |
Other providers in Mountain, WI
- CMH Mountain Primary Care Clinic
- Community Memorial Hospital
- Douglas C Gremban
- St Clare Memorial Hospital, Inc
- St Vincent Hospital-Hospital Sisters-Third Order of St Francis
- Townships of Doty Riverview Mountain Ambulance Service
All providers in Mountain, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2021. 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.