1700174760 NPI number — BEL-REGIONAL HOME MEDICAL INC

Table of content: KRISTEN SHERIFF EDWARDS PT, DPT (NPI 1952652570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700174760 NPI number — BEL-REGIONAL HOME MEDICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEL-REGIONAL HOME MEDICAL 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:
Provider Other Organization Name Type Code:
6
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:
1700174760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23400
Provider Second Line Business Mailing Address:
744 S. WEBSTER AVE
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54305-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-431-5696
Provider Business Mailing Address Fax Number:
920-431-5677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 QUALITY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WRIGHTSTOWN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54180-9006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-532-0700
Provider Business Practice Location Address Fax Number:
920-532-0728
Provider Enumeration Date:
07/12/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STROM
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
TEAM LEADER
Authorized Official Telephone Number:
920-431-5696

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  8904-042 , 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)