Healthcare Provider Details

I. General information

NPI: 1699692533
Provider Name (Legal Business Name): OCONTO HOSPITAL & MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 ROOSEVELT RD
MARINETTE WI
54143-3834
US

IV. Provider business mailing address

PO BOX 1866
GREEN BAY WI
54305-1866
US

V. Phone/Fax

Practice location:
  • Phone: 715-735-5225
  • Fax: 715-735-5388
Mailing address:
  • Phone: 715-735-5225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ABBY JULIA ENGEBOSE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 920-433-7860