Organization Name: | BUFFALO RIVER CLINIC SC |
NPI Number: | 1316099161 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | THOMAS SCRENOCK (CEO) |
Mailing Address: | 12830 Cox Lane Osseo |
State: | WI US |
Postal Code: | 54758 |
Phone Number: | 7155976767 |
Fax Number: | 7155972819 |
NPI Enumeration Date: | 01/18/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |