1649397654 NPI number — FAMILY SERVICES OF NORTHEAST WISCONSIN, INC.

Table of content: DR. JOHN THOMAS WILKINSON M.D. (NPI 1376886663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649397654 NPI number — FAMILY SERVICES OF NORTHEAST WISCONSIN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SERVICES OF NORTHEAST WISCONSIN, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649397654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 CROOKS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54301-4527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-436-6800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 W ROGERS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APPLETON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54914-5007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-954-6804
Provider Business Practice Location Address Fax Number:
920-954-6806
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT-CEO
Authorized Official Telephone Number:
920-436-6800

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  2561 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 43008200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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