Provider Demographics
NPI:1114053048
Name:COMMUNITY CLINIC OF DOOR COUNTY, INC.
Entity Type:Organization
Organization Name:COMMUNITY CLINIC OF DOOR COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-746-8989
Mailing Address - Street 1:1623 RHODE ISLAND ST
Mailing Address - Street 2:P.O. BOX 3
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1424
Mailing Address - Country:US
Mailing Address - Phone:920-746-8989
Mailing Address - Fax:920-746-8960
Practice Address - Street 1:1623 RHODE ISLAND ST
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1424
Practice Address - Country:US
Practice Address - Phone:920-746-8989
Practice Address - Fax:920-746-8960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261Q00000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42012500Medicaid