Provider Demographics
NPI:1134428105
Name:COMMUNITY HEALTH NETWORK
Entity type:Organization
Organization Name:COMMUNITY HEALTH NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUEDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-361-5988
Mailing Address - Street 1:W832 STATE ROAD 91
Mailing Address - Street 2:STE 3
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923-8821
Mailing Address - Country:US
Mailing Address - Phone:920-361-6400
Mailing Address - Fax:920-361-6407
Practice Address - Street 1:W832 STATE ROAD 91
Practice Address - Street 2:STE 3
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923-8821
Practice Address - Country:US
Practice Address - Phone:920-361-6400
Practice Address - Fax:920-361-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11011000Medicaid
WI1276240005Medicare NSC
WI11011000Medicaid