Provider Demographics
NPI:1275943243
Name:ST NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST FRANCIS
Entity Type:Organization
Organization Name:ST NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST FRANCIS
Other - Org Name:ST NICHOLAS HOSPITAL PROFESSIONAL SERVICES GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGNALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-459-4705
Mailing Address - Street 1:3100 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1948
Mailing Address - Country:US
Mailing Address - Phone:920-459-8300
Mailing Address - Fax:
Practice Address - Street 1:3100 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1948
Practice Address - Country:US
Practice Address - Phone:920-459-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST FRANCIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-30
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty