Healthcare Provider Details

I. General information

NPI: 1467583096
Provider Name (Legal Business Name): ST CLARE MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 S MAIN ST SUITE 1
OCONTO FALLS WI
54154-1282
US

IV. Provider business mailing address

835 S MAIN ST SUITE 1
OCONTO FALLS WI
54154-1282
US

V. Phone/Fax

Practice location:
  • Phone: 920-846-8187
  • Fax: 920-846-2073
Mailing address:
  • Phone: 920-846-8187
  • Fax: 920-846-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48740-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38426-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21763-20
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number33603-020
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34230-020
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number39408-020
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1233-023
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2770-033
License Number StateWI
# 9
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1075-033
License Number StateWI
# 10
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA ALLEN
Title or Position: CFO
Credential:
Phone: 920-884-5660