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COMMUNITY MEMORIAL HOSPITAL INCORPORATED NPI 1093096224


NPI Information

NPI: 1093096224
Provider Name: COMMUNITY MEMORIAL HOSPITAL, INCORPORATED

Doing Business As: D/B/A BREAST SURGERY EXPERTS OF NORTHEAST WISCONSIN LLC

Classification: Surgery - 208600000X
Entity Type: Organization
Address:
1726 SHAWANO AVE
GREEN BAY, WI
ZIP 54303
Phone: (920) 360-3787
Get Directions

COMMUNITY MEMORIAL HOSPITAL, INCORPORATED is a surgery in Green Bay, WI. The provider is a general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. COMMUNITY MEMORIAL HOSPITAL, INCORPORATED NPI is 1093096224. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As D/b/a Breast Surgery Experts Of Northeast Wisconsin Llc.

The provider's business location address is:

1726 SHAWANO AVE
GREEN BAY, WI
ZIP 54303-216
Phone: (920) 360-3787
Fax: (888) 848-0225

The provider's authorized official is Daniel Degroot .
The authorized official title is Ceo and has the following contact phone number (920) 846-3444.

The enumeration date for this NPI number is 9/1/2011 and was last updated on 1/13/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208600000XSurgery39597-20WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11851477913OTHERWISCONSINCMH NPI
21750302089OTHERWISCONSINPROVIDER
3WI2552OTHERWISCONSINMEDICARE PTAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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