South Street Clinic Llc

LBN: South Street Clinic Llc
South Street Clinic Llc is an health care organization with primary practice located at 416 W South St , Oconomowoc WI 53066-2755. The organization recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as the primary health care specialty. South Street Clinic Llc can be contacted via phone (262) 567-7673, or through Weston, Anne Alexa via phone (262) 567-7673.

Contact Information

Primary practice address
416 W South St Oconomowoc WI 53066-2755
Phone: (262) 567-7673
Fax: (262) 567-3097
Website:
Map and Directions
Authorized official contact:
Name: Weston, Anne Alexa PHD
Phone: (262) 567-7673

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 1841 Wisconsin

Profile Details

NPI number 1235128356
LBN Legal business name South Street Clinic Llc
DBA Doing business as
Authorized official Weston, Anne Alexa PHD
Entity Organization
Organization subpart 1 No
Enumeration date Oct 20th, 2005
Last updated Aug 22nd, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235128356 NPPES
Wisconsin MEDICAID 42217900

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