Organization
BELLIN MEMORIAL HOSPITAL, INC.
Active
Parent organization
BELLIN MEMORIAL HOSPITAL, INC.
Other names
Bellin Health Outreach Laboratory
Organization subpart
Yes
Provider details
NPI number
Legal business name
BELLIN MEMORIAL HOSPITAL, INC.
Authorized official
MRS. DENISE K STROOBANTS (CREDENTIALING SPECIALIST)
(920) 445-7226
Entity
Organization
Contact information
Practice address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 433-7848
(920) 433-7878
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
52D0662050
WI
291U00000X
Clinical Medical Laboratory
52D0913169
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11010200
—
WI
05
—
32947900
—
WI
01
—
52D0662050
CLIA - CLINICAL LABORATORY IMPROVEMENT AMENDMENTS
WI
01
—
52D0913169
CLIA-CLINIC LABORATORY IMPROVEMENT AMENDMENTS
WI
Enumeration date
04/01/2009
Last updated
05/18/2020
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