Provider Demographics
NPI:1902028541
Name:COUNTY OF PRICE
Entity Type:Organization
Organization Name:COUNTY OF PRICE
Other - Org Name:PRICE COUNTY HEALTH & HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-339-2158
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555-0088
Mailing Address - Country:US
Mailing Address - Phone:715-339-3054
Mailing Address - Fax:715-339-3057
Practice Address - Street 1:104 S EYDER AVENUE
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555
Practice Address - Country:US
Practice Address - Phone:715-339-3054
Practice Address - Fax:715-339-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23944-020251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42008300Medicaid
WI41210700Medicaid
WI44001600Medicaid
WI43081500Medicaid
WI41853200Medicaid
WI990004527Medicare ID - Type UnspecifiedRAILROAD MEDICARE
WI42008300Medicaid
WI000085511Medicare ID - Type UnspecifiedMEDICARE PART B