Provider Demographics
NPI:1972793818
Name:NORTHEAST WISCONSIN TECHNICAL COLLEGE
Entity type:Organization
Organization Name:NORTHEAST WISCONSIN TECHNICAL COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUMREICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-498-5701
Mailing Address - Street 1:2740 W MASON ST
Mailing Address - Street 2:P.O.BOX 19042
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-4966
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2740 W MASON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-4966
Practice Address - Country:US
Practice Address - Phone:920-498-5543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental