MEDICARE: BELLIN MEMORIAL HOSPITAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52D1048462	OTHER	WI	CLIA CERT
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295797975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLIN MEMORIAL HOSPITAL INC

Provider Business Mailing Address
First Line	:	140 B SCHOOL CREEK TRL
Second Line	:
City	:	LUXEMBURG
State	:	WI
Zip	:	54217-1095
Country	:	US
Telephone Number	:	920-845-1370
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 B SCHOOL CREEK TRL
Second Line	:
City	:	LUXEMBURG
State	:	WI
Zip	:	54217-1095
Country	:	US
Telephone Number	:	920-845-1370
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	DENISE K STROOBANTS
Credential	:
Telephone Number	:	920-445-7222

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	03/17/2020

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