Provider Demographics
NPI:1629138995
Name:COUNTY OF OUTAGAMIE
Entity Type:Organization
Organization Name:COUNTY OF OUTAGAMIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR HHS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RATHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-832-5187
Mailing Address - Street 1:320 S. WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5918
Mailing Address - Country:US
Mailing Address - Phone:920-832-4741
Mailing Address - Fax:920-832-5164
Practice Address - Street 1:320 S. WALNUT ST.
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-5918
Practice Address - Country:US
Practice Address - Phone:920-832-4741
Practice Address - Fax:920-832-5164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QM0801X, 261QM1300X, 261QP2300X
WI1724251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41761200Medicaid
WI43074500Medicaid
WI44012800Medicaid
WI42139100Medicaid
WI32978671Medicaid
WI10038416Medicaid
WI41869100Medicaid
WI43106700Medicaid
WI43426000Medicaid