Organization
FORT HEALTHCARE INC
Active
Other names
FORT ATKINSON MEMORIAL HEALTH SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
SHELBY WALLING (CREDENTIALING SPECIALIST)
(920) 563-4466
Entity
Organization
Contact information
Practice address
611 SHERMAN AVE E, FORT ATKINSON, WI 53538-1960
(920) 568-6580
(920) 568-4004
Mailing address
PO BOX 249, FORT ATKINSON, WI 53538-0249
(920) 563-4402
(920) 568-4004
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
152W00000X
Optometrist
—
—
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
208D00000X
General Practice Physician
—
—
231H00000X
Audiologist
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000491
MEDICARE PTAN
—
05
—
11011900
—
WI
05
—
21273800
—
WI
05
—
21273900
—
WI
05
—
21274000
—
WI
05
—
21274100
—
WI
05
—
21274200
—
WI
05
—
21274300
—
WI
05
—
21274500
—
WI
05
—
21274600
—
WI
05
—
21274700
—
WI
05
—
21274800
—
WI
05
—
21274900
—
WI
05
—
21275700
—
WI
05
—
21279400
—
WI
05
—
42237700
—
WI
01
—
52D0392916
CLIA
WI
Enumeration date
06/21/2006
Last updated
10/07/2022
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us