1114908001 NPI number — ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS

Table of content: (NPI 1114908001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114908001 NPI number — ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS
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 VINCENT HOSPITAL
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:
1114908001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13508
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54307-3508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-433-8287
Provider Business Mailing Address Fax Number:
920-433-8765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 S VAN BUREN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54301-3526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-433-8287
Provider Business Practice Location Address Fax Number:
920-433-8765
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  19 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11012100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113963500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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