Provider Demographics
NPI:1245565878
Name:BELLIN MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:BELLIN MEMORIAL HOSPITAL INC
Other - Org Name:FMC ESCANABA
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:920-445-7226
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:610 S LINCOLN RD
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1215
Practice Address - Country:US
Practice Address - Phone:906-786-6488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLIN MEMORIAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-15
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICE8495Medicare Oscar/Certification
MIOP38340Medicare Oscar/Certification