OB-GYN Assoc of Green Bay LTD

Primary specialty

Critical Care Medicine (Obstetrics & Gynecology) PhysicianTaxonomy code 207VC0200X

Legal business name

OB-GYN ASSOC OF GREEN BAY LTD

Practice address

704 S Webster Ave
Ste 300
Green Bay, WI 54301

Phone

(920) 468-3443

Fax

(920) 432-6313

NPI assigned

Nov 3, 2006

Organization subpart

No

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

Authorized official

Name

Robert Knox Demott, MD

Title

Owner Operator

Phone

(920) 468-3443

Specialties & licenses 2

Addresses

Other identifiers 7

Locations

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214870400000",
    "number": "1154400034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 WITTMANN DRIVE",
            "address_2": "HEALTHCARE MANAGEMENT CONSULTANTS",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549523809",
            "telephone_number": "920-886-6565",
            "fax_number": "920-886-6570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 S WEBSTER AVE",
            "address_2": "STE 300",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54301",
            "telephone_number": "920-468-3443",
            "fax_number": "920-432-6313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OB-GYN ASSOC OF GREEN BAY LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2008-07-01",
        "status": "A",
        "authorized_official_last_name": "DEMOTT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "KNOX",
        "authorized_official_title_or_position": "OWNER OPERATOR",
        "authorized_official_telephone_number": "920-468-3443",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207VC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Critical Care Medicine",
            "state": "WI",
            "license": null,
            "primary": true
        },
        {
            "code": "364SF0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "WI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32400300",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41963900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30661000",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30984300",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41964300",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43977500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KIM SHEFCHIK PAC NPI",
            "identifier": "1174547244",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Obstetrics & Gynecology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; 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.