Provider Demographics
NPI:1518134980
Name:BESIADA HEALTH INNOVATORS, LLC
Entity Type:Organization
Organization Name:BESIADA HEALTH INNOVATORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BESIADA HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:920-491-9079
Mailing Address - Street 1:1600 SHAWANO AVE
Mailing Address - Street 2:SUITE 106E
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-3246
Mailing Address - Country:US
Mailing Address - Phone:920-491-9079
Mailing Address - Fax:920-491-9082
Practice Address - Street 1:1600 SHAWANO AVE
Practice Address - Street 2:STE 106E
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3246
Practice Address - Country:US
Practice Address - Phone:920-491-9079
Practice Address - Fax:920-491-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization