Provider Demographics
NPI:1902407786
Name:NORDIC PRIVATE CARE, LLC
Entity Type:Organization
Organization Name:NORDIC PRIVATE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROTHENBURGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-355-6993
Mailing Address - Street 1:814 LYNN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913
Mailing Address - Country:US
Mailing Address - Phone:608-355-6990
Mailing Address - Fax:608-355-2291
Practice Address - Street 1:814 LYNN AVENUE
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913
Practice Address - Country:US
Practice Address - Phone:608-355-6990
Practice Address - Fax:608-355-2291
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORDIC PRIVATE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health