Healthcare Provider Details

I. General information

NPI: 1962869602
Provider Name (Legal Business Name): FLAMBEAU HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 SHERRY AVE
PARK FALLS WI
54552-1467
US

IV. Provider business mailing address

98 SHERRY AVE
PARK FALLS WI
54552-1467
US

V. Phone/Fax

Practice location:
  • Phone: 715-762-2484
  • Fax: 715-762-7558
Mailing address:
  • Phone: 715-762-2484
  • Fax: 715-762-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number1028
License Number StateWI

VIII. Authorized Official

Name: MR. JAMES R. BRAUN
Title or Position: CHIEF FINANCIAL OFFICER
Credential: C.F.O.
Phone: 715-762-7568