Provider Demographics
NPI:1134556657
Name:EAST WIND HEALTHCARE, SC
Entity type:Organization
Organization Name:EAST WIND HEALTHCARE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:H RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-997-0511
Mailing Address - Street 1:2600 N RICHMOND ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1956
Mailing Address - Country:US
Mailing Address - Phone:920-997-0511
Mailing Address - Fax:
Practice Address - Street 1:2600 N RICHMOND ST
Practice Address - Street 2:SUITE C
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1956
Practice Address - Country:US
Practice Address - Phone:920-997-0511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-29
Last Update Date:2013-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29316-20208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty