1346371358 NPI number — ST CLARE MEMORIAL HOSPITAL, INC

Table of content: (NPI 1346371358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346371358 NPI number — ST CLARE MEMORIAL HOSPITAL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST CLARE MEMORIAL HOSPITAL, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST CLARE MEMORIAL HOSPITAL LENA HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346371358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
855 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCONTO FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54154-1241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-846-3444
Provider Business Mailing Address Fax Number:
920-846-0250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S. ROSERA STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-829-6400
Provider Business Practice Location Address Fax Number:
920-829-6403
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
920-884-5660

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  38208-020 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 1428-023 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11014110 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3987482411009 . This is a "RICHLEN BC" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 294946191003 . This is a "CUPINO BC" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1851477913 . This is a "CMH NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 41969700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32392300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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