NPIMap

Organization Active NPI

Creekside Family Medicine, LLC

  • Health Service Clinic/Center
  • Appleton, WI
National Provider Identifier
1558610063
Registry record updated Oct 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
35097870 Issued in OH
Legal business name
CREEKSIDE FAMILY MEDICINE, LLC
Practice address
3608 N Bracken Dr
Appleton, WI 54911-8504
Phone
(330) 466-4431
NPI assigned
Aug 30, 2012
Last updated
Oct 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2014

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

Authorized official

Name
Samuel J Heiks, M.D.
Title
Sole Member
Phone
(330) 466-4431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 35097870 OH Primary

Addresses

Primary practice location

3608 N Bracken Dr
Appleton, WI 54911-8504

Mailing address

3608 N Bracken Dr
Appleton, WI 54911-8504
Phone (330) 466-4431

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413849600000",
    "number": "1558610063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3608 N BRACKEN DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118504",
            "telephone_number": "330-466-4431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3608 N BRACKEN DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118504",
            "telephone_number": "330-466-4431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE FAMILY MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-30",
        "last_updated": "2014-10-21",
        "status": "A",
        "authorized_official_last_name": "HEIKS",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "330-466-4431",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "OH",
            "license": "35097870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2014; 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.