Provider Demographics
NPI:1538353198
Name:COUNTY OF FLORENCE
Entity type:Organization
Organization Name:COUNTY OF FLORENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MS DIRECTOR HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:MARJORIE
Authorized Official - Last Name:SEIBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:715-528-4837
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:WI
Mailing Address - Zip Code:54121-0017
Mailing Address - Country:US
Mailing Address - Phone:715-528-4837
Mailing Address - Fax:715-528-5269
Practice Address - Street 1:501 LAKE AVENUE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:WI
Practice Address - Zip Code:54121-8805
Practice Address - Country:US
Practice Address - Phone:715-528-4837
Practice Address - Fax:715-528-5269
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF FLORENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-28
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44009000Medicaid
WI00004186Medicaid
WI44009000Medicaid
WI000081137Medicare PIN