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General NPI Number Information
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NPI Number | 1629302831
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 855 S MAIN ST
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City | OCONTO FALLS
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State | WI
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Zip | 54154-1241
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Country | US
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Telephone | 920-846-3444
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Fax | 920-846-0250
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Provider Business Mailing Address
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Address Line | 855 S MAIN ST
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City | OCONTO FALLS
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State | WI
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Zip | 54154-1241
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Country | US
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Telephone | 920-846-3444
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Fax | 920-846-0250
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Authorized Official
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Title or Position | CEO
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Name | JIM L VAN DORNICK
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Credential |
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Telephone | 920-846-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6699-123
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7421-123
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License Number State | WI
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