Provider Demographics
NPI:1730126673
Name:APPLETON AREA HEALTH
Entity Type:Organization
Organization Name:APPLETON AREA HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:REDEPENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-289-8514
Mailing Address - Street 1:30 S. BEHL ST.
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:MN
Mailing Address - Zip Code:56208
Mailing Address - Country:US
Mailing Address - Phone:320-289-1580
Mailing Address - Fax:320-289-8538
Practice Address - Street 1:30 S. BEHL ST.
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:MN
Practice Address - Zip Code:56208
Practice Address - Country:US
Practice Address - Phone:320-289-1580
Practice Address - Fax:320-289-8538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN294310700Medicaid
MN243467Medicare Oscar/Certification