Provider Demographics
NPI:1376735373
Name:BELLIN MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BELLIN MEMORIAL HOSPITAL
Other - Org Name:OCCUPATIONAL HEALTH SOLUTIONS EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER CLINIC MAINTENANCE
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:920-445-7222
Mailing Address - Street 1:215 N WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4813
Mailing Address - Country:US
Mailing Address - Phone:920-433-4558
Mailing Address - Fax:
Practice Address - Street 1:215 N WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4813
Practice Address - Country:US
Practice Address - Phone:920-433-4558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========OtherTAX ID