Provider Demographics
NPI:1366820904
Name:SYNERGY MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:SYNERGY MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-573-2107
Mailing Address - Street 1:2480 MARINA CIR UNIT 114
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4875
Mailing Address - Country:US
Mailing Address - Phone:920-360-6282
Mailing Address - Fax:920-283-1278
Practice Address - Street 1:2480 MARINA CIR UNIT 114
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4875
Practice Address - Country:US
Practice Address - Phone:920-360-6282
Practice Address - Fax:920-283-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-15
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44378-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty