Provider Demographics
NPI:1528235033
Name:NORTHREACH HEALTHCARE LLC
Entity type:Organization
Organization Name:NORTHREACH HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:HIPKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-732-2078
Mailing Address - Street 1:3120 RIVERSIDE AVE
Mailing Address - Street 2:GATE B BUILDING 1
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1123
Mailing Address - Country:US
Mailing Address - Phone:715-732-2075
Mailing Address - Fax:715-732-2072
Practice Address - Street 1:441 FRENCH ST
Practice Address - Street 2:
Practice Address - City:PESHTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157-1203
Practice Address - Country:US
Practice Address - Phone:715-582-9949
Practice Address - Fax:715-582-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43060200Medicaid
WI000040160Medicare Oscar/Certification
WI43060200Medicaid