Provider Demographics
NPI:1871556134
Name:BELLIN MEMORIAL HOSPITAL INC
Entity type:Organization
Organization Name:BELLIN MEMORIAL HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/CLINIC MAINTENANCE
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:920-445-7222
Mailing Address - Street 1:124 SIEGLER ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2636
Mailing Address - Country:US
Mailing Address - Phone:920-497-7771
Mailing Address - Fax:
Practice Address - Street 1:124 SIEGLER ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2636
Practice Address - Country:US
Practice Address - Phone:920-497-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32857000Medicaid
WI07355Medicare ID - Type Unspecified
WICE0993Medicare PIN