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General NPI Number Information
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NPI Number | 1700693884
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Entity Type | Organization
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Legal Business Name | SPINE SOLUTIONS OF GREEN BAY LLC
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 2595 DEVELOPMENT DR STE 150
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City | GREEN BAY
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State | WI
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Zip | 54311-4288
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Country | US
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Telephone | 920-204-6758
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Fax |
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Provider Business Mailing Address
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Address Line | DEPT CH 18031
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City | PALATINE
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State | IL
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Zip | 60055-8031
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Country | US
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Telephone | 920-204-6758
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Fax |
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Authorized Official
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Title or Position | MD
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Name | JEREMY ASHTON SCARLETT
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Credential |
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Telephone | 608-710-8162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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