Provider Demographics
NPI:1659471068
Name:CHIPPEWA VALLEY HOSPITAL & OAKVIEW CARE CENTER INC.
Entity Type:Organization
Organization Name:CHIPPEWA VALLEY HOSPITAL & OAKVIEW CARE CENTER INC.
Other - Org Name:ADVENTHEALTH MEDICAL GROUP PRIMARY CARE AT DURAND SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-672-4211
Mailing Address - Street 1:1220 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736-1600
Mailing Address - Country:US
Mailing Address - Phone:715-672-4211
Mailing Address - Fax:715-672-3047
Practice Address - Street 1:1220 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736-1600
Practice Address - Country:US
Practice Address - Phone:715-672-4211
Practice Address - Fax:715-672-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1008207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32798600Medicaid
WI32798600Medicaid