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General NPI Number Information
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NPI Number | 1619305703
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Entity Type | Organization
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Legal Business Name | ST. MARY'S HOSPITAL
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 1726 SHAWANO AVE
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City | GREEN BAY
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State | WI
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Zip | 54303-3216
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Country | US
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Telephone | 920-498-4267
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Fax |
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Provider Business Mailing Address
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Address Line | 1726 SHAWANO AVE
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City | GREEN BAY
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State | WI
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Zip | 54303-3216
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CHIEF EXECUTIVE OFFIC
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Name | THERESE B. PANDL
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Credential |
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Telephone | 920-884-5801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1193624
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License Number State | WI
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