Provider Demographics
NPI:1710130216
Name:BELLIN MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:BELLIN MEMORIAL HOSPITAL INC
Other - Org Name:BELLIN HEALTH HEART AND VASCULAR MANITOWOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC CREDENTIALING
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 1:208 EAST REED STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2121
Mailing Address - Country:US
Mailing Address - Phone:920-264-2920
Mailing Address - Fax:
Practice Address - Street 1:208 EAST REED STREET
Practice Address - Street 2:SUITE B
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2121
Practice Address - Country:US
Practice Address - Phone:920-264-2920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1710130216Medicaid
WI0000010020Medicare Oscar/Certification