# GREEN BAY ROAD MEDICAL SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104131960
- **Authorized official:** JOHN C. MATTEUCCI JR. M.D. (FACILITY DIRECTOR)
- **Authorized official phone:** (262) 653-9221

## Contact information

- **Practice address:** 6127 GREEN BAY ROAD, SUITE 600, KENOSHA, WI 53142-2930
- **Practice address phone:** (262) 653-9221
- **Practice address fax:** (262) 653-9229
- **Mailing address:** 6127 GREEN BAY ROAD, SUITE 600, KENOSHA, WI 53142-2930
- **Mailing address phone:** (262) 653-9221
- **Mailing address fax:** (262) 653-9229

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/17/2010
- **Last updated:** 08/17/2010