Provider Demographics
NPI:1326748104
Name:DOOR COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DOOR COUNTY MEMORIAL HOSPITAL
Other - Org Name:DIRECTCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:LALUZERNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-746-3729
Mailing Address - Street 1:911 GREEN BAY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-3814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:911 GREEN BAY RD STE 103
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-3814
Practice Address - Country:US
Practice Address - Phone:920-746-4565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health