Green Bay Road Medical Services Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GREEN BAY ROAD MEDICAL SERVICES INC

Practice address

6127 Green Bay Road
Suite 600
Kenosha, WI 53142-2930

Phone

(262) 653-9221

Fax

(262) 653-9229

NPI assigned

Aug 17, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John C. Matteucci Jr., M.D.

Title

Facility Director

Phone

(262) 653-9221

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282003200000",
    "number": "1104131960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6127 GREEN BAY ROAD",
            "address_2": "SUITE 600",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422930",
            "telephone_number": "262-653-9221",
            "fax_number": "262-653-9229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6127 GREEN BAY ROAD",
            "address_2": "SUITE 600",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422930",
            "telephone_number": "262-653-9221",
            "fax_number": "262-653-9229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN BAY ROAD MEDICAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-17",
        "last_updated": "2010-08-17",
        "status": "A",
        "authorized_official_last_name": "MATTEUCCI",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "FACILITY DIRECTOR",
        "authorized_official_telephone_number": "262-653-9221",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Thomas Joseph Green III
• Ashley Greenwood, LAT
• Courtney Greenwood
• Gregory a. Santarelli DDS SC

• Ambulatory Surgical Clinic/Center in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Ambulatory Surgical Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.