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ANTIGO MEDICAL BUILDING, LLC
NPI 1396575353
Family Medicine in Antigo, WI

Active since August 05, 2024CLIA 52D0395366 · Waiver
1111 LANGLADE RD, ANTIGO, WI 54409(715) 623-3761(715) 623-3764 Get Directions Write a Review

NPPES record last updated: August 5, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Antigo Medical Building, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANTIGO MEDICAL BUILDING, LLC (NPI 1396575353) is a healthcare organization registered as a family medicine in Antigo, Wisconsin and active in the NPI registry since August 2024. The organization holds a CLIA Waiver certificate valid through November 24, 2026 and lists Michelle Undeen, Credentialing Specialist, as its authorized official.

NPPES Registry Identity

NPI1396575353
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameANTIGO MEDICAL BUILDING, LLC
Location Address1111 LANGLADE RDAntigo, WI 54409-2787
Mailing Address1111 Langlade RdAntigo, WI 54409-2787 · (715) 623-3761 · Fax (715) 623-3764
Phone(715) 623-3761
Fax(715) 623-3764
Organization SubpartNo
Authorized OfficialMichelle UndeenCredentialing Specialist · (239) 427-1257
Enumeration DateAugust 5, 2024
NPPES CertifiedAugust 5, 2024
✔ NPI 1396575353 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
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.
1111 LANGLADE RD, Antigo, WI 54409
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D0395366

Antigo Medical Building · Antigo, WI
Active · expires Nov 24, 2026
CLIA Number52D0395366
Laboratory TypeRural Health Clinic
Certificate Effective DateNovember 25, 2024
Certificate Expiration DateNovember 24, 2026
Laboratory DirectorDr. Steven Weber
Laboratory Phone(715) 623-3761
Laboratory LocationAntigo Medical Building1111 Langlade Rd, Antigo, WI 54409
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WENDEE M. ARROWOOD RDHP
Dental Hygienist
1111 LANGLADE RD
ANTIGO, WI 54409
Langlade County (715) 627-4383
SALLY SIMON
Dental Hygienist
1111 LANGLADE RD
ANTIGO, WI 54409
Langlade County (715) 627-4383
RURAL DENTAL HEALTH PROJECT
General Acute Care Hospital (Critical Access)
1111 LANGLADE RD
ANTIGO, WI 54409
Langlade County (715) 571-6554
EMILY CHRISTIANSON RDH
Dental Hygienist
1111 LANGLADE RD
ANTIGO, WI 54409
Langlade County (715) 627-4383
AMANDA RAE DIERCKS D.C.
Chiropractor
1111 LANGLADE RD
ANTIGO, WI 54409
Langlade County (715) 623-3761
DIERCKS FAMILY HEALTH CTR., LLC
Chiropractor
1111 LANGLADE RD
ANTIGO, WI 54409
Langlade County (715) 623-3761
DARCI LYNN ANN HUNTINGTON RDH
Dental Hygienist
1111 LANGLADE RD
ANTIGO, WI 54409
Langlade County (715) 627-4383
MICHELLE A. OVANS RDHP
Dental Hygienist
1111 LANGLADE RD
ANTIGO, WI 54409
Langlade County (715) 627-4383

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Antigo Medical Building, LLC's NPI number?

The NPI number for Antigo Medical Building, LLC is 1396575353. It was assigned to this organization in the NPPES registry on August 5, 2024.

Where is Antigo Medical Building, LLC located?

Antigo Medical Building, LLC is located at 1111 Langlade Rd, Antigo, WI 54409. The listed phone number is (715) 623-3761.

What is Antigo Medical Building, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Antigo Medical Building, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D0395366) is associated with this NPI, valid through November 24, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Antigo Medical Building, LLC was last updated on August 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.