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General NPI Number Information
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NPI Number | 1811916281
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Entity Type | Organization
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Legal Business Name | FORT HEALTHCARE, INC.
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 611 SHERMAN AVE E
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City | FORT ATKINSON
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State | WI
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Zip | 53538-1960
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Country | US
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Telephone | 920-568-5000
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Fax | 920-568-5412
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Provider Business Mailing Address
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Address Line | PO BOX 249
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City | FORT ATKINSON
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State | WI
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Zip | 53538-0249
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Country | US
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Telephone | 920-568-5000
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Fax | 920-568-5412
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Authorized Official
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Title or Position | VP FINANCE
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Name | MR. JAMES J. NELSON
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Credential |
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Telephone | 920-568-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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 | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 1908-800
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License Number State | WI
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