NPIMap

Organization Active NPI

Northwoods Family Physical Medicine of Wisconsin, S.C.

  • Medical Specialty Clinic/Center
  • Green Bay, WI
National Provider Identifier
1518446558
Registry record updated Aug 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
NORTHWOODS FAMILY PHYSICAL MEDICINE OF WISCONSIN, S.C.
Doing business as
Northwoods Family Physical Medicine
Practice address
2360A Duck Creek Pkwy Ste 2
Green Bay, WI 54303-3377
Phone
(920) 301-3024
Fax
(920) 301-3049
NPI assigned
Aug 10, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2018

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

Authorized official

Name
Dr. Kimberly Scarlassara, DCNPI 1588823520
Title
Clinic Director
Phone
(920) 301-3024

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

2360A Duck Creek Pkwy Ste 2
Green Bay, WI 54303-3377

Mailing address

2360A Duck Creek Pkwy Ste 2
Green Bay, WI 54303-3377
Phone (920) 301-3024

Other names 1

  • Northwoods Family Physical Medicine Doing business as

National Provider Directory

National Provider Directory

Locations

2360A Duck Creek Pkwy
Ste 2
Howard, WI 54303
Phone (920) 301-3024

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1533859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533859200000",
    "number": "1518446558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2360A DUCK CREEK PKWY STE 2",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033377",
            "telephone_number": "920-301-3024",
            "fax_number": "920-301-3049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2360A DUCK CREEK PKWY STE 2",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033377",
            "telephone_number": "920-301-3024",
            "fax_number": "920-301-3049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWOODS FAMILY PHYSICAL MEDICINE OF WISCONSIN, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-10",
        "last_updated": "2018-08-10",
        "status": "A",
        "authorized_official_last_name": "SCARLASSARA",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "920-301-3024",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwoods Family Physical Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2018; 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.