| Dousman Clinic, S.c. | |
|
124 Siegler St Green Bay WI 54303-2636 | |
| (920) 494-9661 | |
| Not Available |
| Full Name | Dousman Clinic, S.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 124 Siegler St, Green Bay, Wisconsin |
| Authorized Official Name and Position | Jan E Reimer (CLINIC MANAGER) |
| Authorized Official Contact | 9204949661 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dousman Clinic, S.c. 124 Siegler St Green Bay WI 54303-2636 Ph: (920) 494-9661 | Dousman Clinic, S.c. 124 Siegler St Green Bay WI 54303-2636 Ph: (920) 494-9661 |
| NPI Number | 1265634331 |
|---|---|
| Provider Enumeration Date | 06/01/2007 |
| Last Update Date | 10/24/2012 |
| Medicare PECOS PAC ID | 6507876323 |
|---|---|
| Medicare Enrollment ID | O20130107000202 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265634331 | NPI | - | NPPES |
| 32786100 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Wisconsin) | Primary |
| Provider Name | Mark Jenson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598727000 PECOS PAC ID: 4688684400 Enrollment ID: I20101025001163 |
| Provider Name | Matthew K Jenson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063917243 PECOS PAC ID: 3577986728 Enrollment ID: I20210819001265 |
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