WEST BEND CLINIC NPI 1518976919

NPI Information

NPI: 1518976919
Provider Name: WEST BEND CLINIC

Other Name: KEWASKUM CLINIC

Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
1701 FOND DU LAC AVE
KEWASKUM, WI
ZIP 53040
Phone: (262) 626-4616
Get Directions

WEST BEND CLINIC is a family medicine in Kewaskum, WI. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. WEST BEND CLINIC NPI is 1518976919. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Kewaskum Clinic.

The provider's business location address is:

1701 FOND DU LAC AVE
KEWASKUM, WI
ZIP 53040-129
Phone: (262) 626-4616

The provider's authorized official is Gregory G Blommel .
The authorized official title is Medical Director and has the following contact phone number (262) 334-3451.

The enumeration date for this NPI number is 8/5/2006 and was last updated on 5/23/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207R00000X	Internal Medicine		No
2	208000000X	Pediatrics		No
3	2085B0100X	Radiology	Body Imaging	No
4	332B00000X	Durable Medical Equipment & Medical Supplies		No
5	207Q00000X	Family Medicine		Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	67025	MEDICARE ID-TYPE UNSPECIFIED	WISCONSIN	GROUP NUMBER
2	21251400	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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