Organization
FORT HEALTHCARE INC
Active
Organization
FORT HEALTHCARE INC
Active
Other names
FORT ATKINSON MEMORIAL HEALTH SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
SHELBY WALLING (PAYER CREDENTIALING SPECIALIST)
(920) 563-4466
Entity
Organization
Contact information
Practice address
611 SHERMAN AVE E, FORT ATKINSON, WI 53538-1960
(920) 563-6667
(920) 563-0145
Mailing address
PO BOX 249, FORT ATKINSON, WI 53538-0249
(920) 563-6580
(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
Primary
—
—
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
06/11/2026
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