MEDICARE: BAYCARE CLINIC, LLP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
2	208VP0014X	Interventional Pain Medicine Physician
3	332B00000X	Durable Medical Equipment & Medical Supplies	WI
4	208100000X	Physical Medicine & Rehabilitation Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285908970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYCARE CLINIC, LLP

Provider Business Mailing Address
First Line	:	PO BOX 28900
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54324-0900
Country	:	US
Telephone Number	:	920-490-9046
Fax Number	:	920-405-8005

Provider Business Practice Location Address
First Line	:	2401 HOLMGREN WAY
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5224
Country	:	US
Telephone Number	:	920-497-0003
Fax Number	:	920-497-0024

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. CHRIS JAY AUGUSTIAN
Credential	:	C.P.A
Telephone Number	:	920-405-5382

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	04/13/2022

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Directions to “BAYCARE CLINIC, LLP ” Practice Location

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