Organization
COAST TO COAST WISCONSIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK BOLTON MD (CEO)
(614) 855-9961
Entity
Organization
Contact information
Practice address
410 DEWEY ST, WISCONSIN RAPIDS, WI 54494-4715
(715) 423-6060
Mailing address
5195 HAMPSTED VILLAGE CENTER WAY, #256, NEW ALBANY, OH 43054-8331
(614) 855-9961
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
02/26/2015
Last updated
02/26/2015
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