Healthcare Provider Details

I. General information

NPI: 1437470572
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HOSPITAL, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 1ST ST
OCONTO WI
54153-1117
US

IV. Provider business mailing address

855 S MAIN ST
OCONTO FALLS WI
54154-1241
US

V. Phone/Fax

Practice location:
  • Phone: 920-835-1144
  • Fax: 920-835-1145
Mailing address:
  • Phone: 920-846-3444
  • Fax: 920-846-0250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL DEGROOT
Title or Position: CEO
Credential:
Phone: 920-846-3444