Provider Demographics
NPI:1972829554
Name:ST. VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS
Entity Type:Organization
Organization Name:ST. VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS
Other - Org Name:PREVEA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST ADMIN/CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIGOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-496-4700
Mailing Address - Street 1:835 S VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3526
Mailing Address - Country:US
Mailing Address - Phone:920-496-4700
Mailing Address - Fax:920-405-1402
Practice Address - Street 1:835 S VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3526
Practice Address - Country:US
Practice Address - Phone:920-496-4700
Practice Address - Fax:920-405-1402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST VINCENT HOSPITAL-HOSPITAL SISTERS-THIRD ORDER OF ST FRANCIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-08
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI52D0689713OtherCLIA
WI52D0689713OtherCLIA