Healthcare Provider Details

I. General information

NPI: 1487878328
Provider Name (Legal Business Name): N.E.W. COMMUNITY CLINIC, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N BROADWAY
GREEN BAY WI
54303-3426
US

IV. Provider business mailing address

622 BODART ST
GREEN BAY WI
54301-4923
US

V. Phone/Fax

Practice location:
  • Phone: 920-437-7206
  • Fax:
Mailing address:
  • Phone: 920-437-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateWI

VIII. Authorized Official

Name: KEITH SZERKINS
Title or Position: CFO
Credential: MSA
Phone: 920-940-8088