Provider Demographics
NPI:1154546695
Name:GENERAL & VASCULAR CONSULTANTS
Entity type:Organization
Organization Name:GENERAL & VASCULAR CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SWIECICHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-965-4714
Mailing Address - Street 1:720 S VAN BUREN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3538
Mailing Address - Country:US
Mailing Address - Phone:920-430-8120
Mailing Address - Fax:920-430-8122
Practice Address - Street 1:720 S VAN BUREN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3538
Practice Address - Country:US
Practice Address - Phone:920-430-8120
Practice Address - Fax:920-430-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21297300Medicaid
WI000007850Medicare PIN