East Side Family Practice Sc

LBN: East Side Family Practice Sc
East Side Family Practice Sc is an health care organization with primary practice located at 424 S Monroe Ave Ste 106 , Green Bay WI 54301-4054. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty. East Side Family Practice Sc can be contacted via phone (920) 437-4366, or through Dobson, Joseph Robert via phone (920) 437-4366.

Contact Information

Primary practice address
424 S Monroe Ave Ste 106 Green Bay WI 54301-4054
Phone: (920) 437-4366
Fax: (920) 437-0954
Website:
Map and Directions
Authorized official contact:
Name: Dobson, Joseph Robert Doctor of Osteopathy (DO)
Phone: (920) 437-4366

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 26550 Wisconsin
Allopathic & Osteopathic Physicians / General Practice 208D00000X 26550 Wisconsin

Profile Details

NPI number 1861527863
LBN Legal business name East Side Family Practice Sc
DBA Doing business as
Authorized official Dobson, Joseph Robert Doctor of Osteopathy (DO)
Entity Organization
Organization subpart 1 No
Enumeration date Feb 22nd, 2007
Last updated Oct 25th, 2010 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861527863 NPPES
Other 80085001 RR MEDICARE PROV #
MEDICAID 30021900 RR MEDICARE PROV #

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