Basic Information
| Provider Information | |||||||||
| NPI: | 1790284438 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCONTO HOSPITAL & MEDICAL CENTER INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BELLIN HEALTH LAKEWOOD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1866 | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543051866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204457222 | ||||||||
| FaxNumber: | 9204457289 | ||||||||
| Practice Location | |||||||||
| Address1: | 15481 COMMERCIAL RD STE E | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541389677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152769048 | ||||||||
| FaxNumber: | 9204457289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2018 | ||||||||
| LastUpdateDate: | 03/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | STROOBANTS | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 9204337864 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OCONTO HOSPITAL & MEDICAL CENTER INC | ||||||||
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| NPICertificationDate: | 03/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.