RANDALL R SOUTHARDS


Address: 2845 Greenbrier Rd Ste 320, Green Bay, WI 54311-6519
Phone: 9202888320

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363A00000X Physician Assistant 1402 WI Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
WI 41958200 05

Office Location

Street Address 2845 GREENBRIER RD STE 320
City GREEN BAY
State WI
Zip Code 54311-6519

Providers in the same location

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

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1295333847 Karen Ginnow Pharmacist Walmart #1908, 2292 Main St, Green Bay, WI 54311 2020-10-15
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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 Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Competitor

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City GREEN BAY
Zip Code 54311

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Dataset Information

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.

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