# BELLIN MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** BELLIN MEDICAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871677419
- **Authorized official:** DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
- **Authorized official phone:** (800) 654-0889

## Contact information

- **Practice address:** 833 S MAIN ST, OCONTO FALLS, WI 54154-1241
- **Practice address phone:** (920) 846-3092
- **Practice address fax:** (920) 846-8313
- **Mailing address:** PO BOX 985, OCONTO FALLS, WI 54154-0985

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | 24066020 | WI | Yes |

## Other

- **Enumeration date:** 10/24/2006
- **Last updated:** 08/22/2020