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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