Provider Demographics
NPI:1316920317
Name:COUNTY OF PIERCE
Entity type:Organization
Organization Name:COUNTY OF PIERCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-273-6755
Mailing Address - Street 1:412 W KINNE ST
Mailing Address - Street 2:P.O. BOX 238
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-9230
Mailing Address - Country:US
Mailing Address - Phone:715-273-6755
Mailing Address - Fax:715-273-6854
Practice Address - Street 1:412 W KINNE ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011-9223
Practice Address - Country:US
Practice Address - Phone:715-273-6755
Practice Address - Fax:715-273-6854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF PIERCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-22
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42552200OtherB3 SPEECH
WI38394800OtherDENTAL SERVICES
WI43089800OtherB3 TCM
WI44001100OtherPRENATAL CARE COORDINATIO
WI000082828Medicare PIN