Provider Demographics
NPI:1902982671
Name:FAMILY HEALTH OF LAFAYETTE COUNTY
Entity Type:Organization
Organization Name:FAMILY HEALTH OF LAFAYETTE COUNTY
Other - Org Name:THE SHULLSBURG CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:NEUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-965-4475
Mailing Address - Street 1:104 S JUDGEMENT ST
Mailing Address - Street 2:P O BOX 176
Mailing Address - City:SHULLSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53586-9549
Mailing Address - Country:US
Mailing Address - Phone:608-965-4475
Mailing Address - Fax:608-965-3186
Practice Address - Street 1:104 S JUDGEMENT ST
Practice Address - Street 2:
Practice Address - City:SHULLSBURG
Practice Address - State:WI
Practice Address - Zip Code:53586-9549
Practice Address - Country:US
Practice Address - Phone:608-965-4475
Practice Address - Fax:608-965-3186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32701300Medicaid
WI35006Medicare ID - Type Unspecified