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General NPI Number Information
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NPI Number | 1487878328
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Entity Type | Organization
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Legal Business Name | N.E.W. COMMUNITY CLINIC, LTD
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 610 N BROADWAY
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City | GREEN BAY
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State | WI
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Zip | 54303-3426
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Country | US
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Telephone | 920-437-7206
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Fax |
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Provider Business Mailing Address
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Address Line | 622 BODART ST
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City | GREEN BAY
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State | WI
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Zip | 54301-4923
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Country | US
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Telephone | 920-437-9773
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | KEITH SZERKINS
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Credential | MSA
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Telephone | 920-940-8088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State | WI
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