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NPI Code Detail

MEDICARE: ST CLARE MEMORIAL HOSPITAL, INC

MEDICARE: ST CLARE 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
1363A00000XPhysician Assistant1515-23WI
2363A00000XPhysician Assistant212-23WI
3207Q00000XFamily Medicine Physician25152-20WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11477750644OTHERNPI FOX
21851477913OTHERCMH NPI
31760462352OTHERNPI KNUTSON
41215024716OTHERNPI BIRK
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467583278
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST CLARE MEMORIAL HOSPITAL, INC
Provider Business Mailing Address
First Line : 103 1ST ST
Second Line :
City : OCONTO
State : WI
Zip : 54153-1117
Country : US
Telephone Number : 920-835-1144
Fax Number : 920-835-1145
Provider Business Practice Location Address
First Line : 103 1ST ST
Second Line :
City : OCONTO
State : WI
Zip : 54153-1117
Country : US
Telephone Number : 920-835-1144
Fax Number : 920-835-1145
Authorized Official
Title or Position : CEO
Name : DANIEL DEGROOT
Credential :
Telephone Number : 920-846-3444
Provider Enumeration Date : 03/07/2007
Last Update Date : 09/02/2014

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