| NPI | 1871767400 |
|---|---|
| Doing Business As | PORTAGE |
| Entity Type | Organization |
| Authorized Contact | SUSAN MARIE ODEGAARD Director, Bus Opers 414-289-3796 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QA0005X Clinic/Center, Ambulatory Family Planning Facility |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2015-10-23 |