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General NPI Number Information
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NPI Number | 1518446558
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Entity Type | Organization
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Legal Business Name | NORTHWOODS FAMILY PHYSICAL MEDICINE OF WISCONSIN, S.C.
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 08/10/2018
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Provider Practice Location Address
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Address Line | 2360A DUCK CREEK PKWY STE 2
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City | GREEN BAY
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State | WI
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Zip | 54303-3377
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Country | US
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Telephone | 920-301-3024
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Fax | 920-301-3049
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Provider Business Mailing Address
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Address Line | 2360A DUCK CREEK PKWY STE 2
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City | GREEN BAY
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State | WI
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Zip | 54303-3377
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Country | US
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Telephone | 920-301-3024
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Fax | 920-301-3049
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. KIMBERLY SCARLASSARA
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Credential | DC
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Telephone | 920-301-3024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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