Provider Demographics
| NPI: | 1033172390 |
|---|---|
| Name: | BELLIN MEMORIAL HOSPITAL INC |
| Entity Type: | Organization |
| Organization Name: | BELLIN MEMORIAL HOSPITAL INC |
| Other - Org Name: | BELLIN HEALTH |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CREDENTIALING SPECIALIST |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | DENISE |
| Authorized Official - Middle Name: | K |
| Authorized Official - Last Name: | STROOBANTS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 920-433-7864 |
| Mailing Address - Street 1: | PO BOX 22487 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | GREEN BAY |
| Mailing Address - State: | WI |
| Mailing Address - Zip Code: | 54305-2487 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 920-445-7210 |
| Mailing Address - Fax: | 920-445-7289 |
| Practice Address - Street 1: | 744 S WEBSTER AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | GREEN BAY |
| Practice Address - State: | WI |
| Practice Address - Zip Code: | 54301-3505 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 920-445-7226 |
| Practice Address - Fax: | 920-445-7229 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-04-08 |
| Last Update Date: | 2024-01-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207VX0201X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | Group - Multi-Specialty |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MI | 0P38340 | Other | MI MEDICARE |
| WI | 000000215 | Other | WI MEDICARE |
| 243966 | Other | US DEPARTMENT OF HEALTH AND HUMAN SERVICES FDA MAMMOGRAPHY CERTIFICATION | |
| WI | 000215 | Medicare Oscar/Certification |
