PREVEA REGIONAL SERVICES, INC. (NPI# 1194748061) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194748061 |
| Entity Type | Organization |
| Organization Name | PREVEA REGIONAL SERVICES, INC. |
| Other Organization Name | PREVEA REGIONAL |
| Practice Address |
2710 Executive Dr Green Bay WI 54304-5496 |
| Mailing Address |
Po Box 19070 Prevea Health Regional Green Bay WI 54307-9070 |
| Practice Telephone | 9204964700 |
| Practice Fax Number | 9204964705 |
| Mailing Telephone | 9204964700 |
| Mailing Fax Number | 9204964705 |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2008-09-10 |
| Authorized Official Name | RICHARD ROLSTON (PRESIDENT AND CEO) |
| Authorized Official Telephone | 9204964700 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Prevea Regional | Doing Business As Name - Organization |
| Street Address |
2710 EXECUTIVE DR |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54304-5496 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285613638 | St Vincent Hospital-hospital Sisters-third Order of St Francis | Family Medicine | 2710 Executive Dr, Green Bay, WI 54304-5496 | 2006-01-13 |
| 1578047452 | Aaron Witt | Physician Assistant | 2710 Executive Dr, Green Bay, WI 54304-5496 | 2018-09-18 |
| 1932650017 | St. Vincent Hospital of The Hospital Sisters-third Order of St. Franci | Physician Assistant | 2710 Executive Dr, Green Bay, WI 54304-5496 | 2016-10-24 |
| 1114389087 | Kayla Branam | Registered Nurse | 2710 Executive Dr, Green Bay, WI 54304-5496 | 2016-03-22 |
| 1306869276 | Prevea Clinic, Inc. | Allergy & Immunology | 2710 Executive Dr, Green Bay, WI 54304-5496 | 2006-07-25 |
| 1548298169 | Laura M Nelson | Internal Medicine | 2710 Executive Dr, Green Bay, WI 54304-5496 | 2006-06-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689196255 | Kristen Ashley Haltom | Registered Nurse | 2979 Allied St Suite C, Green Bay, WI 54304 | 2017-07-14 |
| 1649671421 | Heather Marie Novak | Counselor | 2979 Allied St Unit C, Green Bay, WI 54304 | 2014-09-11 |
| 1356777684 | Nathan Weir | Specialist/Technologist | 1265 Lombardi Avenue, Green Bay, WI 54304 | 2013-09-18 |
| 1922349927 | John W Hartman | Internal Medicine | 916 Willard Dr, Suite 200, Green Bay, WI 54304 | 2013-03-15 |
| 1447551379 | Citralina M Haruo | Community Health Worker | 1110 11th Avenue, Green Bay, WI 54304 | 2010-11-09 |
| 1497061352 | Daniel James Gustin | Pharmacist | 1109 Lombardi Ave, Green Bay, WI 54304 | 2010-08-28 |
| 1316259898 | Karen A Detrick | Occupational Therapy Assistant | 1040 Pilgram Way, Woodside Senior Communities, Green Bay, WI 54304 | 2010-07-13 |
| 1861667362 | Planned Parenthood of Wi, Inc | Non-Pharmacy Dispensing Site | 2605 S. Oneida St. Suite 107, Green Bay, WI 54304 | 2008-04-25 |
| 1891967303 | Kimberley M Welk | Marriage & Family Therapist | 926 Willard Dr Ste 136, Green Bay, WI 54304 | 2008-03-25 |
| 1750563698 | Richard Lawrence Beyer | Hearing Instrument Specialist | 2154 S Ridge Rd, Green Bay, WI 54304 | 2007-12-03 |
| Find all providers in zip 54304 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528259397 | Venkata Ravi Kiran Kadipi Reddy | Family Medicine | 2793 Lineville Road, Green Bay, WI 54307 | 2007-08-07 |
| 1104022128 | Bellin Memorial Hospital Inc | Family Medicine | 704 S Webster Ave Ste 201, Green Bay, WI 54301-3528 | 2007-06-26 |
| 1942336839 | Richard Gordon Heidorn | Family Medicine | 2833 Riverside Dr, Green Bay, WI 54301-1635 | 2007-02-26 |
| 1720137656 | Daniel G Koster Md Sc | Family Medicine | 744 S Webster Ave Fl 5, Green Bay, WI 54301-3505 | 2007-01-09 |
| 1356424691 | Marjorie J Delo | Family Medicine | 2595 Development Dr Ste 140, Green Bay, WI 54311-4267 | 2006-10-23 |
| 1700894433 | Suzanne H Barnes | Family Medicine | 1565 Allouez Ave, Green Bay, WI 54311 | 2006-08-05 |
| 1407871684 | John Tracy Warren | Family Medicine | 1685 Macarthur St, Green Bay, WI 54301-2454 | 2006-07-12 |
| 1255364642 | Gail S Carels | Family Medicine | 2502 S. Ashland Ave, Green Bay, WI 54304 | 2006-07-08 |
| 1346293941 | Bellin Memorial Hospital Inc | Family Medicine | 1976 Lime Kiln Rd, Green Bay, WI 54311-4417 | 2006-05-18 |
| 1073566725 | Bellin Memorial Hospital Inc | Family Medicine | 2015 Shawano Ave, Green Bay, WI 54303-2606 | 2006-05-17 |
| Find all providers in GREEN BAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.