Provider Demographics
NPI:1861691149
Name:NEW ENT SC
Entity type:Organization
Organization Name:NEW ENT SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JILOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-965-4800
Mailing Address - Street 1:923 ELIZA ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3234
Mailing Address - Country:US
Mailing Address - Phone:920-965-4800
Mailing Address - Fax:920-431-7024
Practice Address - Street 1:923 ELIZA ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3234
Practice Address - Country:US
Practice Address - Phone:920-965-4800
Practice Address - Fax:920-431-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4330670001OtherADMINASTAR FEDERAL REGION
WICJ2834OtherMEDICARE RR GROUP
WI32899300OtherWMAP GROUP
WI000007105OtherMEDICARE GROUP
WI000007105OtherMEDICARE GROUP