Provider Demographics
NPI:1700998697
Name:HOLY FAMILY MEMORIAL INC
Entity Type:Organization
Organization Name:HOLY FAMILY MEMORIAL INC
Other - Org Name:FROEDTERT HOLY FAMILY MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VEESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-320-2730
Mailing Address - Street 1:N74W12501 LEATHERWOOD CT STE 103
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4490
Mailing Address - Country:US
Mailing Address - Phone:414-777-0417
Mailing Address - Fax:
Practice Address - Street 1:2300 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-3712
Practice Address - Country:US
Practice Address - Phone:920-320-2011
Practice Address - Fax:920-320-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11014600Medicaid
WI080000002OtherWEA
WI100161517Medicaid
WI=========062OtherBLUE CROSS BLUE SHIELD
WI520107Medicare Oscar/Certification