| Customized Health Care Services, LLC | |
|
108 Packerland Dr Ste D1 Green Bay WI 54303-4862 | |
| (920) 545-5109 | |
| (920) 593-9159 |
| Full Name | Customized Health Care Services, LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 108 Packerland Dr Ste D1, Green Bay, Wisconsin |
| Authorized Official Name and Position | Brian Woodbridge (OWNER) |
| Authorized Official Contact | 9205455109 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Customized Health Care Services, LLC 108 Packerland Dr Ste D1 Green Bay WI 54303-4862 Ph: (920) 545-5109 | Customized Health Care Services, LLC 108 Packerland Dr Ste D1 Green Bay WI 54303-4862 Ph: (920) 545-5109 |
| NPI Number | 1962347641 |
|---|---|
| Provider Enumeration Date | 04/21/2026 |
| Last Update Date | 04/21/2026 |
| Certification Date | 04/21/2026 |
| Medicare PECOS PAC ID | 9537630348 |
|---|---|
| Medicare Enrollment ID | O20260602003916 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962347641 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Secondary |
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Brian S Woodbridge |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720055817 PECOS PAC ID: 7315971868 Enrollment ID: I20050923000241 |
| Provider Name | Stephanie R Smullen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1316117500 PECOS PAC ID: 6002995859 Enrollment ID: I20080505000453 |
| Provider Name | Paul M Smullen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033234406 PECOS PAC ID: 2668665696 Enrollment ID: I20101021001201 |
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