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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