GREEN BAY ONCOLOGY, LTD (NPI# 1649214941) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649214941 |
| Entity Type | Organization |
| Organization Name | GREEN BAY ONCOLOGY, LTD |
| Practice Address |
1726 Shawano Ave Green Bay WI 54303 |
| Mailing Address |
1726 Shawano Ave. Green Bay WI 54303 |
| Practice Telephone | 9208843135 |
| Practice Fax Number | 9208843271 |
| Mailing Telephone | 9208843135 |
| Mailing Fax Number | 9208843271 |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2014-10-28 |
| Authorized Official Name | MS. GINA M MOON (CFO) |
| Authorized Official Telephone | 9209659526 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS GROUP | 110B210240 | 01 |
| DMERC | 0189920001 | 01 | |
| RR MEDICARE | O1037 | 01 | |
| WI | 32769100 | 05 |
| Street Address |
1726 SHAWANO AVE |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356324990 | Thomas M. Farley | Anesthesiology | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2005-11-29 |
| 1265048805 | Hillary Ann Bashaw | Nurse Practitioner | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2020-09-18 |
| 1043828387 | St Mary's Hospital Medical Center of Green Bay Inc.-hospital Sisters | Clinical Medical Laboratory | 1726 Shawano Ave, Green Bay, WI 54303-3282 | 2020-07-22 |
| 1750930079 | Jenna Mae Spude | Nurse Practitioner | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2019-09-09 |
| 1215423504 | Matthew James Dolan | Physician Assistant | 1726 Shawano Ave, Green Bay, WI 54303 | 2018-07-10 |
| 1013430073 | Whitney Jo Brusich | Physician Assistant | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2017-07-21 |
| 1720510043 | Christina R Mestelle | Physical Therapist | 1726 Shawano Ave, Green Bay, WI 54303 | 2017-03-28 |
| 1407231178 | Ahmed Farouk Mohammed | Internal Medicine | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2015-07-23 |
| 1184004236 | St. Vincent Hospital-hospital Sisters-third Order of St. Francis | Internal Medicine | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2015-06-04 |
| 1629468343 | Lynn Wilson | Nurse Practitioner | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2015-02-02 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952921033 | Ashley Marie Vandermoss | Social Worker | 1601 W Mason Street, Green Bay, WI 54303 | 2020-04-20 |
| 1598307423 | Jean Marie Castaneda | Case Manager/Care Coordinator | 2517 N. Court, Green Bay, WI 54303 | 2019-10-11 |
| 1215579552 | Integrated Treatment Centers, LLC | Clinic/Center | 2311 W Mason Street, Green Bay, WI 54303 | 2019-10-08 |
| 1003460551 | Affordable Dentures & Implants - Green Bay, S.c. | Dentist | 1800-c W. Mason Street, Green Bay, WI 54303 | 2019-08-01 |
| 1164940375 | Kaeley Rae Blaney | Student in an Organized Health Care Education/Training Program | 2088 Memorial Drive #208, Green Bay, WI 54303 | 2017-09-07 |
| 1518498047 | Treatment Providers LLC | Clinic/Center | 2731 N Packerland Dr Ste A, Green Bay, WI 54303 | 2017-03-26 |
| 1851840565 | Back To Balance Chiropractic, LLC | Chiropractor | 110 Packerland Drive, Suite B, Green Bay, WI 54303 | 2016-09-23 |
| 1710361001 | Matthew Lemay | Acupuncturist | 727 E Walnut, Suite B2, Green Bay, WI 54303 | 2015-07-16 |
| 1144600149 | Carrie Jean Banaszak | Counselor | 1039 Mason Street, Green Bay, WI 54303 | 2015-06-04 |
| 1174921993 | Kensey Meyer | Occupational Therapy Assistant | 1555 Dousman Road, Seymour, WI 54303 | 2014-12-10 |
| Find all providers in zip 54303 | ||||
| Taxonomy Code | 207RH0003X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology & Oncology |
| An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063730042 | Bradley C Heraly | Internal Medicine | 1726 Shawano Avenue, Green Bay Oncology, Green Bay, WI 54303 | 2010-05-14 |
| 1184004236 | St. Vincent Hospital-hospital Sisters-third Order of St. Francis | Internal Medicine | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2015-06-04 |
| 1225335482 | Nirav D Patel | Internal Medicine | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2011-02-23 |
| 1003129958 | Amritha Chandrahasa Karkera | Internal Medicine | 2845 Greenbrier Rd, Green Bay, WI 54311 | 2010-07-21 |
| 1538321252 | Maria D De Villa | Internal Medicine | 1580 Commanche Ave, Green Bay, WI 54313-5751 | 2008-06-25 |
| 1093987703 | Ubaid Nawaz | Internal Medicine | 2845 Greenbrier Rd, Vlcc, Green Bay, WI 54311-6519 | 2008-04-02 |
| 1649346073 | Paul David Koch | Internal Medicine | 835 S Van Buren St, Green Bay, WI 54301-3526 | 2006-11-28 |
| 1750475851 | Michael J Volk | Internal Medicine | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2006-10-03 |
| 1467546507 | Anthony J Jaslowski | Internal Medicine | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2006-10-03 |
| 1730273889 | Jules H Blank | Internal Medicine | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2006-10-03 |
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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.