Provider Demographics
NPI:1366400848
Name:CHIPPEWA VALLEY EMERGENCY CARE
Entity type:Organization
Organization Name:CHIPPEWA VALLEY EMERGENCY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ER PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:WOLFRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHYNOLL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-839-4121
Mailing Address - Street 1:2715 WEST FRANK STREET
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703
Mailing Address - Country:US
Mailing Address - Phone:715-832-1508
Mailing Address - Fax:715-834-5870
Practice Address - Street 1:900 WEST CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701
Practice Address - Country:US
Practice Address - Phone:715-839-4121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Not Answered207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Not Answered207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical ToxicologyGroup - Single Specialty
Not Answered207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32761000Medicaid