SPACE COAST FAMILY PRACTICE
NPI 1811099054
Clinic/Center in Green Bay, WI

Q: What is Space Coast Family Practice's NPI number?

The NPI number for Space Coast Family Practice is 1811099054. It was assigned to this organization in the NPPES registry on September 1, 2006.

Q: What is Space Coast Family Practice's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Active since September 01, 2006

3067 WINDLAND DR, GREEN BAY, WI 54311(920) 544-5868 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Space Coast Family Practice NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SPACE COAST FAMILY PRACTICE (NPI 1811099054) is a healthcare organization registered as a clinic/center in Green Bay, Wisconsin and active in the NPI registry since September 2006. The organization lists Thomas Charles Betka, President, as its authorized official.

NPPES Registry Identity

NPI1811099054

Entity TypeOrganization

Primary Taxonomy261Q00000X

Legal Business NameSPACE COAST FAMILY PRACTICE

Location Address3067 WINDLAND DRGreen Bay, WI 54311-7574

Mailing Address3067 Windland DrGreen Bay, WI 54311-7574 · (920) 544-5868

Phone(920) 544-5868

Organization SubpartNo

Authorized OfficialThomas Charles BetkaPresident · (920) 544-5868

Enumeration DateSeptember 1, 2006

Last NPPES UpdateAugust 22, 2020

✔ NPI 1811099054 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities

Taxonomy Code261Q00000X

License✔ Licensed in FL · ME88311

Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

3067 WINDLAND DR, Green Bay, WI 54311

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Space Coast Family Practice's NPI number?

The NPI number for Space Coast Family Practice is 1811099054. It was assigned to this organization in the NPPES registry on September 1, 2006.

Where is Space Coast Family Practice located?

Space Coast Family Practice is located at 3067 Windland Dr, Green Bay, WI 54311. The listed phone number is (920) 544-5868.

What is Space Coast Family Practice's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

When was this NPI record last updated?

The NPPES record for Space Coast Family Practice was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.