Provider Demographics
NPI:1548594732
Name:BROWN COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:BROWN COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:920-448-6441
Mailing Address - Street 1:610 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-1533
Mailing Address - Country:US
Mailing Address - Phone:920-448-6400
Mailing Address - Fax:920-448-6449
Practice Address - Street 1:610 S BROADWAY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-1533
Practice Address - Country:US
Practice Address - Phone:920-448-6400
Practice Address - Fax:920-448-6449
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROWN COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-22
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41871500Medicaid