Provider Demographics
NPI:1003811993
Name:WOMEN'S CARE OF WISCONSIN S.C.
Entity Type:Organization
Organization Name:WOMEN'S CARE OF WISCONSIN S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:G
Authorized Official - Last Name:EBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-729-7105
Mailing Address - Street 1:3232 N BALLARD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8804
Mailing Address - Country:US
Mailing Address - Phone:920-729-7105
Mailing Address - Fax:920-831-8306
Practice Address - Street 1:200 THEDA CLARK MEDICAL PLZ STE 130
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2790
Practice Address - Country:US
Practice Address - Phone:920-729-7105
Practice Address - Fax:920-720-2150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI207V00000X
WI41754-20207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32890900Medicaid
WI71525Medicare ID - Type Unspecified
WI45185Medicare ID - Type Unspecified