Provider Demographics
NPI:1467583096
Name:ST CLARE MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:ST CLARE MEMORIAL HOSPITAL, INC
Other - Org Name:ST CLARE MEMORIAL HOSPITAL OCONTO FALLS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-884-5660
Mailing Address - Street 1:835 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1282
Mailing Address - Country:US
Mailing Address - Phone:920-846-8187
Mailing Address - Fax:920-846-2073
Practice Address - Street 1:835 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1282
Practice Address - Country:US
Practice Address - Phone:920-846-8187
Practice Address - Fax:920-846-2073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST CLARE MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38426-020207Q00000X
WI48740-020207Q00000X
WI33603-020207Q00000X
WI34230-020207R00000X
WI39408-020207R00000X
WI21763-20208600000X
261QR1300X
WI1233-023363A00000X
WI2770-033363L00000X
WI1075-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1477532943OtherNPI BALMADRID
1811906555OtherNPI BHATOYA
1851477913OtherNPI CMH
1023092715OtherNPI KLEMENS
WI1639166853OtherLIEBL NPI
1679613475OtherNPI ELKINS
1306825872OtherNPI PEREZ
1023092715OtherNPI KLEMENS
WI0005600439Medicare ID - Type UnspecifiedLINDSAY CLEEREMAN
WI006200439Medicare PIN
1306825872OtherNPI PEREZ
1851477913OtherNPI CMH
WI1639166853OtherLIEBL NPI
1477532943OtherNPI BALMADRID