BETH COLLISTER (NPI# 1427049063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427049063 |
| Entity Type | Individual |
| Full Name | BETH COLLISTER |
| Credential | MD |
| Practice Address |
360 S Mountin Dr Mayville WI 53050-1498 |
| Mailing Address |
420 E Division St Fond Du Lac WI 54935-4560 |
| Practice Telephone | 9203877500 |
| Mailing Telephone | 9209268340 |
| Mailing Fax Number | 9209268370 |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2016-02-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 33156 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | RAILROAD MEDICARE | 080076572 | 01 |
| WI | 31826800 | 05 |
| Street Address |
360 S MOUNTIN DR |
| City | MAYVILLE |
| State | WI |
| Zip Code | 53050-1498 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518514454 | Ashley Nicole Hettich | Physical Therapist | 360 S Mountin Dr, Mayville, WI 53050-1498 | 2019-08-26 |
| 1013486950 | Meredith Ann Weber | Physical Therapist | 360 S Mountin Dr, Mayville, WI 53050-1498 | 2018-11-21 |
| 1861785156 | Karen Lea Bodden | Physical Therapist | 360 S Mountin Dr, Mayville, WI 53050-1498 | 2011-05-19 |
| 1629302187 | Leesa Ann Mcshane | Nurse Practitioner | 360 S Mountin Dr, Mayville, WI 53050-1498 | 2009-09-30 |
| 1497897581 | Consultants Laboratory of Wi, LLC | Clinical Medical Laboratory | 360 S Mountin Dr, Mayville, WI 53050-1498 | 2007-02-13 |
| 1093755068 | Alisha L Ketterer | Family Medicine | 360 S Mountin Dr, Mayville, WI 53050-1498 | 2006-06-07 |
| 1033156260 | Lisa Traughber | Physical Therapist | 360 S Mountin Dr, Mayville, WI 53050-1498 | 2006-05-31 |
| 1477514537 | Agnesian Healthcare Inc | Durable Medical Equipment & Medical Supplies | 360 S Mountin Dr, Mayville, WI 53050-1498 | 2006-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639728496 | Quad/med, LLC | Clinic/Center | 725 South Street, Mayville, WI 53050 | 2019-09-05 |
| 1427262989 | Ellen Anne Demeyer | Occupational Therapist | 305 S. Clark St., Mayville, WI 53050 | 2007-05-10 |
| 1477683142 | Horicon Street Chiropractic, S.c. | Chiropractor | 935 Horicon St., Mayville, WI 53050 | 2007-03-06 |
| 1649316514 | Cyndi L Jurgensen | Chiropractor | 935 Horicon, Mayville, WI 53050 | 2007-01-29 |
| 1164841110 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 2050 Horicon St, Mayville, WI 53050 | 2014-04-07 |
| 1194032383 | Jennifer Radke | Occupational Therapy Assistant | 210 Mary St, Apt. 103, Mayville, WI 53050-1080 | 2010-09-09 |
| 1841733474 | Joy Wagner | Marriage & Family Therapist | 668 N Main St Ste 7, Mayville, WI 53050-1249 | 2016-11-30 |
| 1255953923 | Healing Relationships LLC | Marriage & Family Therapist | 668 N Main St Ste 7, Mayville, WI 53050-1249 | 2020-05-15 |
| 1851396931 | James John Herget | Dentist | 1766 Horicon St, Mayville, WI 53050-1256 | 2005-06-16 |
| 1649484528 | Amy Karin Kulig | Pharmacist | 2050 Horicon St, Mayville, WI 53050-1423 | 2007-05-09 |
| Find all providers in zip 53050 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619072204 | Family Health Medical Services Pllc | Family Medicine | 95 East Chautauqua St., Mayville, NY 14757-0168 | 2006-09-14 |
| 1154821387 | Mayville Family Practice LLC | Family Medicine | 130 S Main St, Mayville, WI 53050-1620 | 2018-02-14 |
| 1750835054 | Paladina Health, LLC | Family Medicine | 11 S Main St, Mayville, WI 53050-1641 | 2016-08-04 |
| 1831578541 | Travis Waswick | Family Medicine | 600 1st St Se, Mayville, ND 58257 | 2015-05-27 |
| 1114281250 | Sanford Health Network North | Family Medicine | 600 1st St Se, Mayville, ND 58257-1518 | 2012-07-03 |
| 1851610950 | Jeremy Martin Riedesel | Family Medicine | 95 E Chautauqua St, Mayville, NY 14757-0168 | 2010-05-28 |
| 1063672749 | Jane Ostlie | Family Medicine | 600 1st St Se, Mayville, ND 58257-1518 | 2008-06-16 |
| 1376625103 | Charles E Sammis | Family Medicine | 130 S Main St, Mayville, WI 53050-1620 | 2006-10-20 |
| 1316028400 | Maria Livieratos | Family Medicine | 2180 E Ohmer Rd, Mayville, MI 48744 | 2006-10-17 |
| 1093755068 | Alisha L Ketterer | Family Medicine | 360 S Mountin Dr, Mayville, WI 53050-1498 | 2006-06-07 |
| Find all providers in MAYVILLE | ||||
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| 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.