Healthcare Provider Details

I. General information

NPI: 1710130216
Provider Name (Legal Business Name): BELLIN MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 EAST REED STREET SUITE B
MANITOWOC WI
54220-2121
US

IV. Provider business mailing address

208 EAST REED STREET SUITE B
MANITOWOC WI
54220-2121
US

V. Phone/Fax

Practice location:
  • Phone: 920-264-2920
  • Fax:
Mailing address:
  • Phone: 920-264-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1710130216
Identifier TypeMEDICAID
Identifier StateWI
Identifier Issuer

VIII. Authorized Official

Name: DENISE K STROOBANTS
Title or Position: CLINIC CREDENTIALING
Credential:
Phone: 920-445-7222