Provider Demographics
NPI:1003115064
Name:COMMUNITY HEALTH NETWORK INC
Entity Type:Organization
Organization Name:COMMUNITY HEALTH NETWORK INC
Other - Org Name:CHN MEDICAL CENTER RIPON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-361-5988
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-0307
Mailing Address - Country:US
Mailing Address - Phone:920-748-7000
Mailing Address - Fax:920-748-7236
Practice Address - Street 1:1080 W FOND DU LAC ST
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-9286
Practice Address - Country:US
Practice Address - Phone:920-748-7000
Practice Address - Fax:920-748-7236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11011000Medicaid
WI00416Medicare PIN