Provider Demographics
NPI:1376649509
Name:BELLIN MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:BELLIN MEMORIAL HOSPITAL INC
Other - Org Name:BELLIN HEALTH HEART & VASCULAR CRYSTAL FALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALSIT
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 1:1328 US HWY 2
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL FALLS
Mailing Address - State:MI
Mailing Address - Zip Code:49920
Mailing Address - Country:US
Mailing Address - Phone:906-776-0550
Mailing Address - Fax:
Practice Address - Street 1:1328 US HWY 2
Practice Address - Street 2:
Practice Address - City:CRYSTAL FALLS
Practice Address - State:MI
Practice Address - Zip Code:49920
Practice Address - Country:US
Practice Address - Phone:906-776-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087525207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========OtherTAX ID