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Organization
HEMOPHILIA OUTREACH OF WISCONSIN, INC.
Active
Organization
HEMOPHILIA OUTREACH OF WISCONSIN, INC.
Active
Other names
Hemophilia Outreach Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMISON BUXTON (EXECUTIVE DIRECTOR)
(920) 965-0606
Entity
Organization
Contact information
Practice address
2060 BELLEVUE ST, GREEN BAY, WI 54311-5622
(920) 965-0606
(920) 965-0607
Mailing address
2060 BELLEVUE ST, GREEN BAY, WI 54311-5622
(920) 965-0606
(920) 965-0607
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
Primary
40681
WI
332900000X
Non-Pharmacy Dispensing Site
5123170
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32850600
—
WI
01
—
5123170
NCPDP NUMBER
WI
Enumeration date
07/14/2005
Last updated
02/01/2022
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