RANDOM LAKE SPINE & SPORTS CLINIC (NPI# 1659543205) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659543205 |
| Entity Type | Organization |
| Organization Name | RANDOM LAKE SPINE & SPORTS CLINIC |
| Practice Address |
321 Carroll St. Random Lake WI 53075 |
| Mailing Address |
Po Box 196 Random Lake WI 53075-0196 |
| Practice Telephone | 9209942000 |
| Mailing Telephone | 9209942000 |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2008-06-02 |
| Authorized Official Name | DR. JASON C RUDELICH (PRESIDENT) |
| Authorized Official Telephone | 9209942000 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Street Address |
321 CARROLL ST. |
| City | RANDOM LAKE |
| State | WI |
| Zip Code | 53075 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134335169 | Jill Shea Suess | Occupational Therapist | 402 First Street, Random Lake, WI 53075 | 2007-05-15 |
| 1285854240 | Random Lake Medical Center LLC | Family Medicine | N639 Silver Creek Cascade Road, Random Lake, WI 53075 | 2007-05-01 |
| 1437274925 | Barbara Alice Weber | Family Medicine | N639 Silver Creek Cascade Rd, Random Lake, WI 53075 | 2007-03-21 |
| 1487980074 | Megan C Horn | Occupational Therapist | 402 First Street, Random Lake, WI 53075 | 2009-11-02 |
| 1790916443 | Virginia K Bowen | Physical Therapist | 402 First Street, Random Lake, WI 53075 | 2009-07-29 |
| 1679701742 | Jamie L. Carter | Occupational Therapist | 402 First Street, Random Lake, WI 53075 | 2009-06-29 |
| 1205032786 | Valerie Jean Stone | Occupational Therapist | 402 First Street, Random Lake, WI 53075 | 2007-06-22 |
| 1316978893 | Jensen Interhealth | Physical Therapist | 233 Carroll St, Random Lake, WI 53075 | 2006-07-05 |
| 1629380167 | Amie L Wilson | Occupational Therapist | 402 First St, Random Lake, WI 53075-0323 | 2010-07-13 |
| 1891092102 | Angela Marie Becker | Occupational Therapist | 402 First Street, Random Lake, WI 53075-0323 | 2011-02-23 |
| Find all providers in zip 53075 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699064022 | Prohealth Chiropractic Center S.c. | Clinic/Center | 321 Carroll St, Random Lake, WI 53075-1813 | 2011-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437757986 | Wonderland Therapy LLC | Clinic/Center | 2116 Winnebago St, La Crosse, WI 54601-5060 | 2020-10-15 |
| 1124633870 | Aspirus Riverview Hospital & Clinics, Inc. | Clinic/Center | 146 N Central Ave, Marshfield, WI 54449-2173 | 2020-09-10 |
| 1952915639 | Gundersen Clinic Ltd | Clinic/Center | 2615 George St, La Crosse, WI 54603-1670 | 2020-09-01 |
| 1194337212 | Accident and Injury Rehab Center, Inc | Clinic/Center | 6114 W Capitol Dr Ste 100-102, Milwaukee, WI 53216-2147 | 2020-08-19 |
| 1275159147 | American Current Care P.a. | Clinic/Center | 6302 75th St, Kenosha, WI 53142-3506 | 2020-06-17 |
| 1326683749 | A.b.d.h. Counseling Services LLC | Clinic/Center | 518 E Concordia Avenue, Milwaukee, WI 53212 | 2019-11-08 |
| 1598318818 | Acorn Dietetics, LLC | Clinic/Center | 906 10th Ave, New Glarus, WI 53574-9765 | 2019-07-17 |
| 1205493582 | Freedom Family Chiropractic | Clinic/Center | 809 Phillips Blvd, Sauk City, WI 53583-1313 | 2019-05-22 |
| 1376001578 | Lowtwillc | Clinic/Center | 2323 N Mayfair Rd Ste 104, Wauwatosa, WI 53226-1506 | 2019-03-06 |
| 1154889749 | Positive Directions Inc | Clinic/Center | 3510 W Saint Paul Ave # 6, Milwaukee, WI 53208-4125 | 2019-03-04 |
| Find all providers with the same taxonomy | ||||
| City | RANDOM LAKE |
| Zip Code | 53075 |
Please comment or provide details below to improve the information on RANDOM LAKE SPINE & SPORTS CLINIC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.