# WEST BEND CLINIC, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** West Bend Clinic South
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558371104
- **Authorized official:** GREGORY G BLOMMEL (MEDICAL DIRECTOR)
- **Authorized official phone:** (262) 334-3451

## Contact information

- **Practice address:** 3200 PLEASANT VALLEY RD, WEST BEND, WI 53095-9274
- **Practice address phone:** (262) 334-3451
- **Mailing address:** 1700 W PARADISE DR, WEST BEND, WI 53095-9795
- **Mailing address phone:** (262) 334-3451

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | — | NULL | — |
| 207RC0001X | Clinical Cardiac Electrophysiology Physician | — | — | — |
| 207RP1001X | Pulmonary Disease Physician | — | NULL | — |
| 207RP1001X | Pulmonary Disease Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | NULL | — |
| 207VM0101X | Maternal & Fetal Medicine Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 08/08/2006
- **Last updated:** 05/23/2012