Provider Demographics
NPI:1134321656
Name:MANITOWOC COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:MANITOWOC COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WERGIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:920-683-4155
Mailing Address - Street 1:1028 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-5343
Mailing Address - Country:US
Mailing Address - Phone:920-683-4155
Mailing Address - Fax:920-683-4156
Practice Address - Street 1:1028 S 9TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5343
Practice Address - Country:US
Practice Address - Phone:920-683-4155
Practice Address - Fax:920-683-4156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MANITOWOC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-05
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41871100Medicaid
WI44014800Medicaid
WI43083100Medicaid