GREEN BAY RADIOLOGY SC (NPI# 1447327986) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447327986 |
| Entity Type | Organization |
| Organization Name | GREEN BAY RADIOLOGY SC |
| Practice Address |
2941 S Ridge Rd Green Bay WI 54304-5517 |
| Practice Telephone | 9203364096 |
| Practice Fax Number | 9203368093 |
| Mailing Telephone | 9203364096 |
| Mailing Fax Number | 9203368093 |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2010-07-30 |
| Authorized Official Name | MRS. LEEANN M WETLI (MANAGER) |
| Authorized Official Telephone | 9209640480 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
WI | Allopathic & Osteopathic Physicians | |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32692400 | 05 |
| Street Address |
2941 S RIDGE RD |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54304-5517 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033187927 | Jeremy Boone Mccue | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304-5517 | 2006-03-08 |
| 1497198022 | Kristin E Joachim | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304-5517 | 2013-04-13 |
| 1669738043 | Frederick George Joachim IIi | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304 | 2012-04-10 |
| 1811263304 | Brandon Charles Bodager | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304 | 2012-03-28 |
| 1447480256 | Tyler J Bailey | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304-5517 | 2009-07-15 |
| 1003962416 | Nami P Zarvan | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304-5517 | 2007-01-26 |
| 1053467456 | James I Sladky | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304-5517 | 2007-01-26 |
| 1619023009 | Joshua D Riebe | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304-5517 | 2007-01-26 |
| 1174679575 | Ian A Sproat | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304-5517 | 2007-01-26 |
| 1851447262 | Robert H Tambeaux | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304-5517 | 2007-01-26 |
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| 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 |
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| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043256159 | William L Hingtgen | Radiology | 1789 Shawano, Green Bay, WI 54303 | 2006-06-20 |
| 1033172390 | Bellin Memorial Hospital Inc | Radiology | 1580 Commanche Ave Ste 102, Green Bay, WI 54313-5751 | 2006-04-08 |
| 1033187927 | Jeremy Boone Mccue | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304-5517 | 2006-03-08 |
| 1144206814 | Jeff C Arnholt | Radiology | 1789 Shawano Ave, Radiology Chartered, Green Bay, WI 54303-3243 | 2005-12-15 |
| 1497198022 | Kristin E Joachim | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304-5517 | 2013-04-13 |
| 1255698221 | Mark Andrew Welnick | Radiology | 744 S Webster Ave, Green Bay, WI 54301-3505 | 2012-04-16 |
| 1669738043 | Frederick George Joachim IIi | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304 | 2012-04-10 |
| 1811263304 | Brandon Charles Bodager | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304 | 2012-03-28 |
| 1447480256 | Tyler J Bailey | Radiology | 2941 S Ridge Rd, Green Bay, WI 54304-5517 | 2009-07-15 |
| 1710142237 | Jordan Elizabeth Toman | Radiology | 164 N Broadway, Green Bay, WI 54303-2728 | 2008-07-24 |
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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.