Organization
PRIMARY CONNECTION HEALTH CARE, INC.
Active
Other names
Bridge Community Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER SMITH (EXECUTIVE DIRECTOR)
(715) 848-4884
Entity
Organization
Contact information
Practice address
181 N 2ND STREET, WAUSAU, WI 54403
(715) 848-4884
(715) 845-5385
Mailing address
1810 2ND ST, WAUSAU, WI 54403-3492
(715) 848-4884
(715) 845-5385
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5377-800
WI
124Q00000X
Dental Hygienist
5377-800
WI
207Q00000X
Family Medicine Physician
5377-800
WI
208000000X
Pediatrics Physician
5377-800
WI
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39256400
—
WI
Enumeration date
07/18/2006
Last updated
06/30/2017
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