Healthcare Provider Details

I. General information

NPI: 1629787114
Provider Name (Legal Business Name): DOOR COUNTY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 MAIN RD
WASHINGTON ISLAND WI
54246-9004
US

IV. Provider business mailing address

910 MAIN RD
WASHINGTON ISLAND WI
54246-9004
US

V. Phone/Fax

Practice location:
  • Phone: 920-743-5566
  • Fax:
Mailing address:
  • Phone: 920-743-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: ANDREW S LALAUZERNE
Title or Position: CFO
Credential:
Phone: 920-746-3729