Provider Demographics
NPI:1801845250
Name:HOSPITAL DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:HOSPITAL DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHIAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-617-2051
Mailing Address - Street 1:200 E WASHINGTON ST
Mailing Address - Street 2:P O BOX 8031
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5490
Mailing Address - Country:US
Mailing Address - Phone:888-505-0558
Mailing Address - Fax:920-739-0124
Practice Address - Street 1:744 S WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3505
Practice Address - Country:US
Practice Address - Phone:920-433-3640
Practice Address - Fax:920-433-3716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32701700Medicaid
WI=========015OtherBLUE CROSS GROUP ID #
WI07265Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #
WI=========015OtherBLUE CROSS GROUP ID #