Provider Demographics
NPI:1336435585
Name:HOLY FAMILY MEMORIAL INC
Entity Type:Organization
Organization Name:HOLY FAMILY MEMORIAL INC
Other - Org Name:HFM RHEUMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR HEALTH INFORMATION MGMT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-320-3444
Mailing Address - Street 1:PO BOX 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-2591
Mailing Address - Fax:920-320-4155
Practice Address - Street 1:1650 S 41ST ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-7316
Practice Address - Country:US
Practice Address - Phone:920-320-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY FAMILY MEMORIAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty