CREEKSIDE FAMILY MEDICINE, LLC (NPI# 1558610063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558610063 |
| Entity Type | Organization |
| Organization Name | CREEKSIDE FAMILY MEDICINE, LLC |
| Practice Address |
3608 N Bracken Dr Appleton WI 54911-8504 |
| Practice Telephone | 3304664431 |
| Mailing Telephone | 3304664431 |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2014-10-21 |
| Authorized Official Name | SAMUEL J HEIKS (SOLE MEMBER) |
| Authorized Official Telephone | 3304664431 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QH0100X |
Clinic/Center Specialization: Health Service |
35097870 | OH | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992922595 | Creekside Family Medicine, LLC | Clinic/Center | 2859 State St, Suite 103, Medford, OR 97504-4348 | 2007-04-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | CREEKSIDE FAMILY MEDICINE, LLC | 2859 State St Ste 103, Medford, OR 97504 |
| Street Address |
3608 N BRACKEN DR |
| City | APPLETON |
| State | WI |
| Zip Code | 54911-8504 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912545633 | Brotherly Love, LLC | Day Training, Developmentally Disabled Services | 1513 E Frances St, Appleton, WI 54911 | 2019-12-12 |
| 1952952129 | Eagle Point Senior Living Inc | Assisted Living Facility | 995 East John Street, Appleton, WI 54911 | 2019-09-27 |
| 1619524766 | University Rx LLC | Pharmacy | 133 E College Ave, Appleton, WI 54911 | 2019-08-23 |
| 1174080063 | Shayla Russell | Counselor | Outagamie County Health and Human Services, 320 S. Walnut St., Appleton, WI 54911 | 2019-02-27 |
| 1871086645 | Megan Kilsdonk | Health Educator | 1604 N Meade St, Appleton, WI 54911 | 2018-06-07 |
| 1871085480 | Tanya Lynn Vickery | Social Worker | 410 S. Elm St., Appleton, WI 54911 | 2018-05-31 |
| 1013407501 | Teri G Metropulos | Counselor | 229 S. Morrison, Appleton, WI 54911 | 2018-05-10 |
| 1093211211 | Bonnie Anne Korytkowski | Student in an Organized Health Care Education/Training Program | 229 S. Morrison Street, Appleton, WI 54911 | 2018-04-05 |
| 1639673940 | Brett Follett | Psychologist | 401 S. Elm St., Appleton, WI 54911 | 2018-03-21 |
| 1700202892 | Brian Withrow | Counselor | 607 West 7th St., Appleton, WI 54911 | 2014-03-13 |
| Find all providers in zip 54911 | ||||
| Taxonomy Code | 261QH0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Health Service |
| Definition to come... |
| Notes: [7/1/2006: modified title] |
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|---|---|---|---|---|
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| 1588910442 | Acupuncture & Herb Center, Inc. | Clinic/Center | 2911 N Ballard Rd, Appleton, WI 54911-8705 | 2012-07-30 |
| 1528204682 | Appleton Chiropractic, Inc. | Clinic/Center | 2425 W Wisconsin Ave, Appleton, WI 54914-3110 | 2008-12-19 |
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| 1699334441 | Mvmt Performance & Rehabilitation | Clinic/Center | 2866 Gentle Hills Dr, De Pere, WI 54115-8157 | 2019-06-06 |
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| 1912358128 | Achieve Wellness, LLC | Clinic/Center | 3300 Birch St Ste 1b, Eau Claire, WI 54703-2297 | 2016-06-29 |
| 1003276841 | Mobile Medical Diagnostic Services LLC | Clinic/Center | 5205 S 13th St, Unit E, Milwaukee, WI 53221-3648 | 2016-03-04 |
| 1821458811 | Kutaiba Al Ithawi | Clinic/Center | 5205 S 13th St Unit E, Milwaukee, WI 53221-3648 | 2016-03-03 |
| 1053794412 | Nc Mobile Health, LLC | Clinic/Center | 801 County Road Hh, Stevens Point, WI 54481-8415 | 2015-07-02 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.