Provider Demographics
NPI:1588666853
Name:APPLETON EMERGENCY SERVICES S C
Entity Type:Organization
Organization Name:APPLETON EMERGENCY SERVICES S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHOPRA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:920-763-6900
Mailing Address - Street 1:PO BOX 12249
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32120-2249
Mailing Address - Country:US
Mailing Address - Phone:386-274-7800
Mailing Address - Fax:386-274-7801
Practice Address - Street 1:1818 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3454
Practice Address - Country:US
Practice Address - Phone:800-968-6866
Practice Address - Fax:616-532-7230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36870207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21314300Medicaid
WICK2123OtherRAILROAD MEDICARE
WI21314300Medicaid
WI=========033OtherBCBS