GRASS ROOTS HEALTH FOODS (NPI# 1679843700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679843700 |
| Entity Type | Organization |
| Organization Name | GRASS ROOTS HEALTH FOODS |
| Practice Address |
3440 State Highway 70 E Eagle River WI 54521-9491 |
| Practice Telephone | 7154796299 |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2012-01-05 |
| Authorized Official Name | MR. DAVID G. KOLLER (OWNER) |
| Authorized Official Telephone | 7154796299 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335G00000X | Medical Foods Supplier | ========= | WI | Suppliers |
| Street Address |
3440 STATE HIGHWAY 70 E |
| City | EAGLE RIVER |
| State | WI |
| Zip Code | 54521-9491 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851999163 | Michelle Kay Root-mcdaniel | Psychologist | 846 Metaloon Trail, Eagle River, WI 54521 | 2020-10-09 |
| 1609488766 | Laray Alan Thompson | Pharmacist | 123 E Wall St, Eagle River, WI 54521 | 2020-08-20 |
| 1659914059 | Florence E Figueroa | Technician | 1204 Fire Tree Trl., Eagle River, WI 54521 | 2019-10-18 |
| 1366933152 | Kristine Cloutier | Acupuncturist | 109 S Main St., Eagle River, WI 54521 | 2018-05-29 |
| 1669889689 | Bradley Camp | Dentist | 415 East Wall Street, Eagle River, WI 54521 | 2014-07-22 |
| 1407188493 | Robert Edwin Bartos | Surgery | 7890 Sanctuary Drive, Eagle River, WI 54521 | 2010-02-02 |
| 1508013319 | Neal Potrykus | Dentist | 213 N. Railroad St., Eagle River, WI 54521 | 2008-08-22 |
| 1972629848 | Scott David Beattie | Dentist | 415 E Wall St, Eagle River, WI 54521 | 2007-03-22 |
| 1396870432 | Potrykus Family Dentistry LLC | Dentist | 213 N Railroad St, Eagle River, WI 54521 | 2007-02-22 |
| 1053481473 | Redman & Gelinas S C | Eyewear Supplier (Equipment, not the service) | 141 B South Willow Street, Eagle River, WI 54521 | 2006-11-09 |
| Find all providers in zip 54521 | ||||
| Taxonomy Code | 335G00000X |
| Grouping | Suppliers |
| Classification | Medical Foods Supplier |
| A supplier of special replacement foods for clients with errors of metabolism that prohibit them from eating a regular diet. Medical foods are lacking in the compounds which cause complications of the metabolic disorder, and are not generally available in grocery stores, health food stores, or pharmacies. |
| Notes: Source: The Children with Special Healthcare Needs (CSHCN) Services Program, a program of the Texas Department of State Health Services |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548529332 | Good Harvest Market | Medical Foods Supplier | 1850 Meadow Ln, Pewaukee, WI 53072-5572 | 2012-05-14 |
| City | EAGLE RIVER |
| Zip Code | 54521 |
Please comment or provide details below to improve the information on GRASS ROOTS HEALTH FOODS.
| 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.