Provider Demographics
NPI:1861531683
Name:BAYFIELD COUNTY
Entity type:Organization
Organization Name:BAYFIELD COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COY
Authorized Official - Suffix:
Authorized Official - Credentials:RS/REHS, MPH
Authorized Official - Phone:715-373-3321
Mailing Address - Street 1:PO BOX 403
Mailing Address - Street 2:
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-1142
Mailing Address - Country:US
Mailing Address - Phone:715-373-6109
Mailing Address - Fax:715-373-6307
Practice Address - Street 1:117 E SIXTH STREET
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891-1142
Practice Address - Country:US
Practice Address - Phone:715-373-6109
Practice Address - Fax:715-373-6307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF BAYFIELD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QF0050X, 261QP2300X
WI251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41851800Medicaid
WI44008600Medicaid
WI43081400Medicaid
WI41521600Medicaid
WI41521600Medicaid