LA CLINICA DE LOS CAMPESINOS INC NPI 1790786929

NPI Information

NPI: 1790786929
Provider Name: LA CLINICA DE LOS CAMPESINOS, INC

Doing Business As: MAUSTON DENTAL CENTER

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
3125 MAIN ST
STEVENS POINT, WI
ZIP 54481
Phone: (920) 787-5514
Get Directions

LA CLINICA DE LOS CAMPESINOS, INC is a federally qualified health center (fqhc) clinic center in Stevens Point, WI. LA CLINICA DE LOS CAMPESINOS, INC NPI is 1790786929. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Mauston Dental Center.

The provider's business location address is:

3125 MAIN ST
STEVENS POINT, WI
ZIP 54481-269
Phone: (920) 787-5514
Fax: (920) 787-4737

The provider's authorized official is Erin Lamore .
The authorized official title is Enrollment And Credentialing Spec. and has the following contact phone number (920) 787-9459.

The CLIA number assigned to this NPI record is 52D0398011 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/10/2005 and was last updated on 2/15/2023.

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	License State	Primary
1	207Q00000X	Family Medicine		WISCONSIN	No
2	207Q00000X	Family Medicine			No
3	122300000X	Dentist		WISCONSIN	No
4	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)		No
5	363LF0000X	Nurse Practitioner	Family		No
6	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)		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
1	100076513	MEDICAID	WISCONSIN
2	100080272	MEDICAID	WISCONSIN
3	32955200	MEDICAID	WISCONSIN
4	100076692	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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