Organization
MAINSTREET CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARYL L DEWITT (ADMINISTRATOR)
(715) 682-5601
Entity
Organization
Contact information
Practice address
1001 MAIN ST W, ASHLAND, WI 54806-1307
(715) 682-5601
(715) 682-6878
Mailing address
1001 MAIN ST W, ASHLAND, WI 54806-1307
(715) 682-5601
(715) 682-6878
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32852600
—
WI
Enumeration date
08/03/2006
Last updated
07/21/2022
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