1700963048 NPI number — FLAMBEAU HOSPITAL INC

Table of content: (NPI 1700963048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700963048 NPI number — FLAMBEAU HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLAMBEAU 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:
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:
1700963048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 N OAK AVE
Provider Second Line Business Mailing Address:
ATTN: PROVIDER ENROLLMENT SERVICES SHP FL2
Provider Business Mailing Address City Name:
MARSHFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54449-5703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-389-0660
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98 SHERRY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARK FALLS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54552-1467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-762-2484
Provider Business Practice Location Address Fax Number:
715-762-7558
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRESSLER
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
COO, AO
Authorized Official Telephone Number:
715-975-6018

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  1028 , 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: 41347800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11016710 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41813100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 43411900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11016700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41638500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32761800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32945500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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