Provider Demographics
NPI:1164476214
Name:ADVANCED CARE FOR WOMEN, SC
Entity Type:Organization
Organization Name:ADVANCED CARE FOR WOMEN, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:COUSSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-888-2828
Mailing Address - Street 1:2411 HOLMGREN WAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5224
Mailing Address - Country:US
Mailing Address - Phone:920-888-2828
Mailing Address - Fax:888-876-4773
Practice Address - Street 1:2411 HOLMGREN WAY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5224
Practice Address - Country:US
Practice Address - Phone:920-888-2828
Practice Address - Fax:888-876-4773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000007075Medicare PIN