Healthcare Provider Details

I. General information

NPI: 1245414374
Provider Name (Legal Business Name): ST. JOSEPH'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 KOHLER MEMORIAL DR
SHEBOYGAN WI
53081-3100
US

IV. Provider business mailing address

2661 COUNTY HIGHWAY I
CHIPPEWA FALLS WI
54729-5407
US

V. Phone/Fax

Practice location:
  • Phone: 920-498-8600
  • Fax:
Mailing address:
  • Phone: 715-723-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: DAVID FISH
Title or Position: ADMINISTRATOR
Credential:
Phone: 715-726-3200