Provider Demographics
NPI:1962464784
Name:BELLIN MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:BELLIN MEMORIAL HOSPITAL INC
Other - Org Name:FMC BRILLION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
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:920-433-7864
Mailing Address - Street 1:235 E RYAN ST
Mailing Address - Street 2:
Mailing Address - City:BRILLION
Mailing Address - State:WI
Mailing Address - Zip Code:54110-1132
Mailing Address - Country:US
Mailing Address - Phone:920-756-2055
Mailing Address - Fax:920-756-3350
Practice Address - Street 1:235 E RYAN ST
Practice Address - Street 2:
Practice Address - City:BRILLION
Practice Address - State:WI
Practice Address - Zip Code:54110-1132
Practice Address - Country:US
Practice Address - Phone:920-756-2055
Practice Address - Fax:715-756-3350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLIN MEMORIAL HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-05
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32833900Medicaid
CE0993Medicare Oscar/Certification
WI000010020Medicare Oscar/Certification
WI000080030Medicare Oscar/Certification