MEDICARE: ADVANCED CARE FOR WOMEN, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VE0102X	Reproductive Endocrinology Physician
2	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1164476214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CARE FOR WOMEN, SC

Provider Business Mailing Address
First Line	:	2411 HOLMGREN WAY
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5224
Country	:	US
Telephone Number	:	920-888-2828
Fax Number	:	888-876-4773

Provider Business Practice Location Address
First Line	:	2411 HOLMGREN WAY
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5224
Country	:	US
Telephone Number	:	920-888-2828
Fax Number	:	888-876-4773

Authorized Official
Title or Position	:	OWNER
Name	:	HERBERT S COUSSONS
Credential	:
Telephone Number	:	920-888-2828

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	09/04/2025

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