Healthcare Provider Details

I. General information

NPI: 1780851501
Provider Name (Legal Business Name): ST CLARE MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 S MAIN ST
OCONTO FALLS WI
54154-1241
US

IV. Provider business mailing address

855 S MAIN ST
OCONTO FALLS WI
54154-1241
US

V. Phone/Fax

Practice location:
  • Phone: 920-846-3444
  • Fax: 920-846-3166
Mailing address:
  • Phone: 920-846-3444
  • Fax: 920-846-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

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