Provider Demographics
NPI:1942425210
Name:ALTERNATIVE HEALTHCARE FAMILY PRACTICE CENTER LLC
Entity type:Organization
Organization Name:ALTERNATIVE HEALTHCARE FAMILY PRACTICE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:262-740-0900
Mailing Address - Street 1:312 S 7TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1964
Mailing Address - Country:US
Mailing Address - Phone:262-740-0900
Mailing Address - Fax:262-740-0909
Practice Address - Street 1:312 S 7TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-1964
Practice Address - Country:US
Practice Address - Phone:262-740-0900
Practice Address - Fax:262-740-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44907-021261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44907-021OtherSTATE LICENSE
WIH82688Medicare UPIN