Provider Demographics
NPI:1215778576
Name:CLEAR PATH CLINIC SC
Entity type:Organization
Organization Name:CLEAR PATH CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:ABATECOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-434-1058
Mailing Address - Street 1:26 PHIPPS AVE
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868
Mailing Address - Country:US
Mailing Address - Phone:705-434-1058
Mailing Address - Fax:715-434-1068
Practice Address - Street 1:26 PHIPPS AVE
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868
Practice Address - Country:US
Practice Address - Phone:705-434-1058
Practice Address - Fax:715-434-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care