Provider Demographics
NPI:1760035513
Name:INTERRA HEALTH INC.
Entity type:Organization
Organization Name:INTERRA HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IMPLEMENTATION & TRAINING COORD
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-375-2827
Mailing Address - Street 1:8919 W HEATHER AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2417
Mailing Address - Country:US
Mailing Address - Phone:414-375-1600
Mailing Address - Fax:414-375-1636
Practice Address - Street 1:831 SIMPSON RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5328
Practice Address - Country:US
Practice Address - Phone:407-483-5757
Practice Address - Fax:407-483-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care