Healthcare Provider Details

I. General information

NPI: 1508224510
Provider Name (Legal Business Name): ST. CLARE MEMORIAL HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 ROOSEVELT RD SUITE 105
MARINETTE WI
54143-3884
US

IV. Provider business mailing address

855 S MAIN ST
OCONTO FALLS WI
54154-1241
US

V. Phone/Fax

Practice location:
  • Phone: 920-846-9995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL DEGROOT
Title or Position: COO
Credential:
Phone: 920-846-4581