| N.e.w. Community Clinic, Ltd | |
|
610 N Broadway Green Bay WI 54303-3426 | |
| (920) 437-7206 | |
| Not Available |
| Full Name | N.e.w. Community Clinic, Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 610 N Broadway, Green Bay, Wisconsin |
| Authorized Official Name and Position | Keith Szerkins (CFO) |
| Authorized Official Contact | 9209408088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| N.e.w. Community Clinic, Ltd 622 Bodart St Green Bay WI 54301-4923 Ph: (920) 437-9773 | N.e.w. Community Clinic, Ltd 610 N Broadway Green Bay WI 54303-3426 Ph: (920) 437-7206 |
| NPI Number | 1487878328 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 08/21/2024 |
| Medicare PECOS PAC ID | 5890912539 |
|---|---|
| Medicare Enrollment ID | O20151013000558 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487878328 | NPI | - | NPPES |
| 100078554 | Medicaid | WI | |
| 32957300 | Medicaid | WI | |
| 100078454 | Medicaid | WI | |
| 41860101 | Medicaid | WI | |
| 100078475 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Wisconsin) | Primary |
| Provider Name | Richard L Erdman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1326090697 PECOS PAC ID: 3678543527 Enrollment ID: I20040728000667 |
| Provider Name | John M Hale |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1518016880 PECOS PAC ID: 9638105943 Enrollment ID: I20050708000532 |
| Provider Name | Holly Kempers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477856581 PECOS PAC ID: 2860629888 Enrollment ID: I20131219001587 |
| Provider Name | Michelle Fowles-ceva |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316594468 PECOS PAC ID: 0648600189 Enrollment ID: I20200423001709 |
| Provider Name | Kathrine Patterson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508239773 PECOS PAC ID: 6002217288 Enrollment ID: I20210624003314 |
| Provider Name | Sheli Faust |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1548619828 PECOS PAC ID: 0345683199 Enrollment ID: I20240208001229 |
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