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NPI Code Detail

MEDICARE: BAYCARE CLINIC LLP

MEDICARE: BAYCARE CLINIC LLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1427086057
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAYCARE CLINIC LLP
Provider Business Mailing Address
First Line : PO BOX 28900
Second Line :
City : GREEN BAY
State : WI
Zip : 54324-0900
Country : US
Telephone Number : 920-490-9046
Fax Number : 920-405-5388
Provider Business Practice Location Address
First Line : 4061 OLD PESHTIGO RD
Second Line :
City : MARINETTE
State : WI
Zip : 54143-3887
Country : US
Telephone Number : 715-732-0420
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. CHRIS JAY AUGUSTIAN
Credential : C.P.A
Telephone Number : 920-405-5382
Provider Enumeration Date : 06/30/2006
Last Update Date : 04/13/2022

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Directions to “BAYCARE CLINIC LLP ” Practice Location

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