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NPI Code Detail

MEDICARE: FORT HEALTHCARE INC

MEDICARE: FORT HEALTHCARE 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
1207Q00000XFamily Medicine Physician
2207V00000XObstetrics & Gynecology Physician
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
4261QR1300XRural Health Clinic/CenterWI

General Provider Information

NPI Number : 1417450115
Entity Type Code : Organization
Provider Name (Legal Business Name) : FORT HEALTHCARE INC
Provider Business Mailing Address
First Line : PO BOX 249
Second Line :
City : FORT ATKINSON
State : WI
Zip : 53538-0249
Country : US
Telephone Number : 920-568-5411
Fax Number : 920-568-4004
Provider Business Practice Location Address
First Line : 500 MCMILLEN ST
Second Line :
City : FORT ATKINSON
State : WI
Zip : 53538-1233
Country : US
Telephone Number : 920-563-5571
Fax Number : 920-563-7705
Authorized Official
Title or Position : CREDENTIALING
Name : SHELBY WALLING
Credential :
Telephone Number : 920-563-4466
Provider Enumeration Date : 03/09/2018
Last Update Date : 10/07/2022

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1518540657 — DR. CAITLIN VICTORIA MARY FLEMING MD/MBA
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Directions to “FORT HEALTHCARE INC ” Practice Location

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