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Organization
BELLIN MEDICAL GROUP
Active
Organization
BELLIN MEDICAL GROUP
Active
Other names
BELLIN MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
833 S MAIN ST, OCONTO FALLS, WI 54154-1241
(920) 846-3092
(920) 846-8313
Mailing address
PO BOX 985, OCONTO FALLS, WI 54154-0985
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
24066020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30611600
—
WI
01
—
5125427
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
10/24/2006
Last updated
08/22/2020
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