Provider Demographics
NPI:1194828442
Name:HOLY FAMILY MEMORIAL INC
Entity Type:Organization
Organization Name:HOLY FAMILY MEMORIAL INC
Other - Org Name:HFM WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VEESER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:920-320-2730
Mailing Address - Street 1:N74W12501 LEATHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4303 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-3066
Practice Address - Country:US
Practice Address - Phone:920-320-6705
Practice Address - Fax:920-320-2436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY FAMILY MEMORIAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-05
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21263200Medicaid
WI100165959Medicaid