Provider Demographics
NPI:1417082629
Name:NEONATAL CONSULTANTS, S.C.
Entity Type:Organization
Organization Name:NEONATAL CONSULTANTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SERVAIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-983-9401
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-0057
Mailing Address - Country:US
Mailing Address - Phone:920-983-9401
Mailing Address - Fax:920-983-9402
Practice Address - Street 1:835 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3526
Practice Address - Country:US
Practice Address - Phone:920-983-9401
Practice Address - Fax:920-983-9408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32760100Medicaid
WI=========012OtherANTHEM BLUE CROSS BLUE SH