Healthcare Provider Details

I. General information

NPI: 1003215476
Provider Name (Legal Business Name): OCONTO COUNTY HEALTH AND HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 PARK AVE
OCONTO WI
54153-1612
US

IV. Provider business mailing address

501 PARK AVE
OCONTO WI
54153-1612
US

V. Phone/Fax

Practice location:
  • Phone: 920-834-7000
  • Fax:
Mailing address:
  • Phone: 920-834-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT SHACKELFORD
Title or Position: DIRECTOR
Credential:
Phone: 920-834-7000