Provider Demographics
NPI:1356373302
Name:OCONTO HOSPITAL & MEDICAL CENTER INC
Entity type:Organization
Organization Name:OCONTO HOSPITAL & MEDICAL CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:920-445-7226
Mailing Address - Street 1:820 ARBUTUS AVE
Mailing Address - Street 2:
Mailing Address - City:OCONTO
Mailing Address - State:WI
Mailing Address - Zip Code:54153
Mailing Address - Country:US
Mailing Address - Phone:920-835-1100
Mailing Address - Fax:
Practice Address - Street 1:820 ARBUTUS AVE
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153
Practice Address - Country:US
Practice Address - Phone:920-835-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
275N00000X, 282N00000X, 282NC0060X
WI52D1040142291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282N00000XHospitalsGeneral Acute Care Hospital
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11024610Medicaid
WI309OtherLICENSE
WI521356Medicare Oscar/Certification
WI52Z356Medicare Oscar/Certification
WI000003028Medicare Oscar/Certification
WI11024610Medicaid