Healthcare Provider Details

I. General information

NPI: 1538405691
Provider Name (Legal Business Name): BELLIN MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 05/27/2020
Certification Date: 05/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 LOMBARDI ACCESS RD SUITE H
GREEN BAY WI
54304-4059
US

IV. Provider business mailing address

1241 LOMBARDI ACCESS RD SUITE H
GREEN BAY WI
54304-4059
US

V. Phone/Fax

Practice location:
  • Phone: 920-445-7000
  • Fax:
Mailing address:
  • Phone: 920-445-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENISE K STROOBANTS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 920-445-7226