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Contact Information

GBR SHEBOYGAN LLC
3100 SUPERIOR AVE
SHEBOYGAN, WI53081-1948
 Phone: 920-964-0480
 Fax: 920-336-8093
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Diagnostic Radiology

2085R0202X 30 Physician/Diagnostic Radiology
 

Vascular & Interventional Radiology

2085R0204X 94 Physician/Interventional Radiology
Indicates primary specialty

NPI Profile & details for GBR SHEBOYGAN LLC

NPI # 1467529917
LBN Legal business name GBR SHEBOYGAN LLC
Authorized official JIMMY DADO - (DIRECTOR OF REVENUE CYCLE)
Entity Organization
Organization subpart 1 No
Enumeration date 11/29/2006
Last updated 05/29/2026 - Less than a week ago
Identifiers
WI Medicaid 21284500
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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