NORTHEAST OBGYN SC – NPI #1508936154
Obstetrics & Gynecology

An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.

NORTHEAST OBGYN SC is a provider located in GLENDALE, WI. NPPES has assigned the NPI number 1508936154 to NORTHEAST OBGYN SC on November 09, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 207V00000X from the Health Care Provider Taxonomy code set, which is classified as Obstetrics & Gynecology.

The NPI profile was previously updated about 5 years ago on Aug 13, 2021. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for NORTHEAST OBGYN SC below.

NPI Profile for
NORTHEAST OBGYN SC

NPI Number
1508936154
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
NORTHEAST OBGYN SC
Primary location
7040 N PORT WASHINGTON RD
SUITE 400
GLENDALE, WI 53217-3838
Phone: (414) 228-8888 Fax: (414) 228-8390
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
GARY FAIT
PRESIDENT
Phone: (414) 228-8888
Updated
Certification Date
Aug 13, 2021

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for NORTHEAST OBGYN SC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDWI31388400
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
207V00000X
- Obstetrics & Gynecology (Primary)
WI

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.