Provider Demographics
NPI:1740549773
Name:COMMUNITY HEALTH NETWORK INC
Entity type:Organization
Organization Name:COMMUNITY HEALTH NETWORK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLAGENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-361-5341
Mailing Address - Street 1:191 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-1241
Mailing Address - Country:US
Mailing Address - Phone:920-361-2500
Mailing Address - Fax:920-361-2973
Practice Address - Street 1:191 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-1241
Practice Address - Country:US
Practice Address - Phone:920-361-2500
Practice Address - Fax:920-361-2973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22113207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1276240004Medicare NSC
WI00416Medicare PIN