Healthcare Provider Details

I. General information

NPI: 1427216993
Provider Name (Legal Business Name): MINISTRY HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 SOUTH 18TH AVE 323 SOUTH 18TH AVE
STURGEON BAY WI
54235-1495
US

IV. Provider business mailing address

323 S 18TH AVE
STURGEON BAY WI
54235-1401
US

V. Phone/Fax

Practice location:
  • Phone: 262-285-3483
  • Fax:
Mailing address:
  • Phone: 920-743-5566
  • Fax: 800-522-8919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number1593
License Number StateGA

VIII. Authorized Official

Name: MR. GERALD GRIFFITH
Title or Position: PHYSICIAN ASSISTANT
Credential:
Phone: 920-743-5566