Provider Demographics
NPI:1609018589
Name:OCONTO HOSPITAL & MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:OCONTO HOSPITAL & MEDICAL CENTER, INC.
Other - Org Name:OCONTO CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
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 1:820 ARBUTUS AVE
Mailing Address - Street 2:
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153-2004
Mailing Address - Country:US
Mailing Address - Phone:920-835-1100
Mailing Address - Fax:920-835-1099
Practice Address - Street 1:820 ARBUTUS AVE
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153-2004
Practice Address - Country:US
Practice Address - Phone:920-835-1100
Practice Address - Fax:920-835-1099
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OCONTO HOSPITAL & MEDICAL CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-24
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1609018589Medicaid
WI528554Medicare Oscar/Certification
WI000003028Medicare Oscar/Certification
WI1609018589Medicaid