Organization
BOSCOBEL CLINIC, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM P FAST MD (PRESIDENT)
(608) 375-4144
Entity
Organization
Contact information
Practice address
208 PARKER ST, BOSCOBEL, WI 53805-1648
(608) 375-4144
(608) 375-5629
Mailing address
208 PARKER ST, BOSCOBEL, WI 53805-1648
(608) 375-4144
(608) 375-5629
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32687700
—
WI
Enumeration date
03/02/2006
Last updated
08/22/2020
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