Organization
PRIMARY CONNECTION HEALTH CARE, INC.
Active
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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