Provider Demographics
NPI:1871313718
Name:FAMILY HEALTH CENTER OF MARSHFIELD, INC.
Entity type:Organization
Organization Name:FAMILY HEALTH CENTER OF MARSHFIELD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NYCZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-387-9137
Mailing Address - Street 1:1307 N SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1340
Mailing Address - Country:US
Mailing Address - Phone:715-221-5600
Mailing Address - Fax:
Practice Address - Street 1:5110N W HWY 51
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:WI
Practice Address - Zip Code:54547-8900
Practice Address - Country:US
Practice Address - Phone:715-221-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)