RANDALL R SOUTHARDS (NPI# 1841233186) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841233186 |
| Entity Type | Individual |
| Full Name | RANDALL R SOUTHARDS |
| Credential | PA |
| Practice Address |
2845 Greenbrier Rd Ste 320 Green Bay WI 54311-6519 |
| Mailing Address |
2845 Greenbrier Rd Ste 320 Po Box 8900 Green Bay WI 54308-8900 |
| Practice Telephone | 9202888320 |
| Practice Fax Number | 9202888325 |
| Mailing Telephone | 9202888320 |
| Mailing Fax Number | 9202888325 |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2008-09-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 1402 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 41958200 | 05 |
| Street Address |
2845 GREENBRIER RD STE 320 |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54311-6519 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720090434 | Gary R Hawkins Jr. | Physician Assistant | 2845 Greenbrier Rd Ste 320, Green Bay, WI 54311-6519 | 2006-08-12 |
| 1255358685 | Alexander Roitstein | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2845 Greenbrier Rd Ste 320, Green Bay, WI 54311-6519 | 2006-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295333847 | Karen Ginnow | Pharmacist | Walmart #1908, 2292 Main St, Green Bay, WI 54311 | 2020-10-15 |
| 1639786551 | Maggie Hall | Dental Hygienist | 2633 Development Dr. Ste 40, Green Bay, WI 54311 | 2020-09-24 |
| 1295370807 | Jennifer Marie Arendt | Technician | 2970 Mossy Oak Cir #39, Green Bay, WI 54311 | 2019-11-07 |
| 1518508803 | Cheryl Ann Johnson | Specialist | 830 Edgewood Dr., Green Bay, WI 54311 | 2019-10-08 |
| 1124670898 | Robert H Wagner Family Dentist S.c. | Dentist | 2830 Curry Court, Suite 1, Green Bay, WI 54311 | 2019-07-12 |
| 1821659624 | The Salvation Army | Counselor | The Salvation Army Ray & Joan Kroc Center, 1315 Lime Kiln Road, Green Bay, WI 54311 | 2019-06-24 |
| 1578052866 | Matthew Robert Wagner | Dentist | 2830 Curry Ln #1, Green Bay, WI 54311 | 2018-05-02 |
| 1861916769 | Atlas Spinal Care | Chiropractor | 2069 Central Ct, Suite 11, Green Bay, WI 54311 | 2017-08-01 |
| 1851844161 | Green Bay Family Dental LLC | Dentist | 2609 Development Dr., Green Bay, WI 54311 | 2016-08-03 |
| 1710382809 | Betsy Hoida | Pharmacist | 2485 Greenbrier Rd., Green Bay, WI 54311 | 2014-10-31 |
| Find all providers in zip 54311 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700253101 | Mathias Dahnert | Physician Assistant | 945 S Irwin Ave, Green Bay, WI 54301-3309 | 2015-09-01 |
| 1770992067 | Sheila M Teddy | Physician Assistant | 2595 Development Dr Ste 150, Green Bay, WI 54311-4288 | 2014-08-12 |
| 1245652718 | Bailey Bauer | Physician Assistant | 2753 Mayline Dr, Green Bay, WI 54311-9646 | 2014-01-17 |
| 1588949333 | Carissa Ann Coorough | Physician Assistant | 720 S Van Buren St Ste 301, Green Bay, WI 54301-3534 | 2011-10-12 |
| 1093942047 | Taresa B Fassbender | Physician Assistant | 3263 Eaton Rd Ste 1, Green Bay, WI 54311-6830 | 2009-06-17 |
| 1265628507 | Colleen M Van Egeren | Physician Assistant | 715 Superior Rd, Suite 120, Green Bay, WI 54311-7594 | 2007-09-20 |
| 1427079516 | Dermatology Clinic S.c. | Physician Assistant | 715 Superior Rd Ste 120, Green Bay, WI 54311-7595 | 2006-07-22 |
| 1316976814 | Kevin F Nelson | Physician Assistant | 3237 Voyager Dr, Green Bay, WI 54311-8349 | 2006-06-30 |
| 1285684662 | Elaine M Smith | Physician Assistant | 301 Bay Park Sq, Green Bay, WI 54304-5104 | 2006-05-10 |
| 1184609331 | Penny S Cornelius | Physician Assistant | 2618 Forestville Dr, Green Bay, WI 54304-1358 | 2005-12-09 |
| 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.