Organization
BAYCARE CLINIC LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRIS JAY AUGUSTIAN C.P.A (CHIEF EXECUTIVE OFFICER)
(920) 405-5382
Entity
Organization
Contact information
Practice address
501 N 10TH ST, MANITOWOC, WI 54220-4039
(920) 682-6376
(920) 652-0115
Mailing address
PO BOX 28900, GREEN BAY, WI 54324-0900
(920) 490-9046
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588609648
—
WI
Enumeration date
09/29/2006
Last updated
03/31/2022
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