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General NPI Number Information
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NPI Number | 1740549773
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Entity Type | Organization
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Legal Business Name | COMMUNITY HEALTH NETWORK INC
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 191 MEMORIAL DR
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City | BERLIN
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State | WI
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Zip | 54923-1241
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Country | US
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Telephone | 920-361-2500
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Fax | 920-361-2973
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Provider Business Mailing Address
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Address Line | 191 MEMORIAL DR
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City | BERLIN
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State | WI
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Zip | 54923-1241
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Country | US
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Telephone | 920-361-2500
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Fax | 920-361-2973
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAYNE A PLAGENZ
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Credential |
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Telephone | 920-361-5341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 22113
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License Number State | WI
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