Provider Demographics
NPI:1154318657
Name:WINNEBAGO COUNTY
Entity Type:Organization
Organization Name:WINNEBAGO COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GIERYN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:920-232-3000
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:725 BUTLER AVE
Mailing Address - City:WINNEBAGO
Mailing Address - State:WI
Mailing Address - Zip Code:54985-0068
Mailing Address - Country:US
Mailing Address - Phone:920-232-3000
Mailing Address - Fax:920-303-3023
Practice Address - Street 1:725 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:WI
Practice Address - Zip Code:54985-0068
Practice Address - Country:US
Practice Address - Phone:920-232-3000
Practice Address - Fax:920-303-3023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41855400Medicaid
WI43082500Medicaid
WI43104000Medicaid
WI44003400Medicaid
WI41855400Medicaid