Provider Demographics
NPI:1962465229
Name:BELLIN MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:BELLIN MEMORIAL HOSPITAL INC
Other - Org Name:FMC HOWARD
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 1:2714 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-6715
Mailing Address - Country:US
Mailing Address - Phone:920-430-4760
Mailing Address - Fax:
Practice Address - Street 1:2714 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-6715
Practice Address - Country:US
Practice Address - Phone:920-430-4760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32856800Medicaid
WI00007305Medicare Oscar/Certification
000080030Medicare Oscar/Certification
WI32856800Medicaid
WI080035Medicare Oscar/Certification