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General NPI Number Information
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NPI Number | 1104418037
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Entity Type | Organization
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Legal Business Name | OCONTO HOSPITAL & MEDICAL CENTER INC
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Dates
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Enumeration Date | 02/11/2021
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 307 MANOR DR
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City | SURING
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State | WI
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Zip | 54174-9182
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Country | US
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Telephone | 920-842-2144
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Fax | 920-842-4111
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Provider Business Mailing Address
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Address Line | PO BOX 1866
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City | GREEN BAY
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State | WI
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Zip | 54305-1866
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Country | US
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Telephone | 920-445-7222
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Fax | 920-445-7289
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | DENISE K STROOBANTS
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Credential |
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Telephone | 920-433-7864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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