ST CLARE MEMORIAL HOSPITAL, INC

Provider Demographics

• NPI: 1144541285
• Name: ST CLARE MEMORIAL HOSPITAL, INC
• Entity type: Organization
• Organization Name: ST CLARE MEMORIAL HOSPITAL, INC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: DANIEL
• Authorized Official - Last Name: DEGROOT
• Authorized Official - Phone: 920-846-3444
• Mailing Address - Street 1: 855 S MAIN ST
• Mailing Address - City: OCONTO FALLS
• Mailing Address - State: WI
• Mailing Address - Zip Code: 54154-1241
• Mailing Address - Country: US
• Mailing Address - Phone: 920-846-3444
• Mailing Address - Fax: 920-846-0250
• Practice Address - Street 1: 855 S MAIN ST
• Practice Address - City: OCONTO FALLS
• Practice Address - State: WI
• Practice Address - Zip Code: 54154-1241
• Practice Address - Country: US
• Practice Address - Phone: 920-846-3444
• Practice Address - Fax: 920-846-0754
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: ST CLARE MEMORIAL HOSPTIAL, INC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2010-06-11
• Last Update Date: 2021-12-23

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	225X00000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Occupational Therapist		Group - Multi-Specialty
No	235Z00000X	Speech, Language and Hearing Service Providers	Speech-Language Pathologist		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WI	1619140092	Other	WAGNER NPI
WI	1639342611	Other	COLLINS NPI
WI	11014110	Medicaid
WI	1376716746	Other	KRAUSE NPI
WI	1811135338	Other	GASSER NPI
	1851477913	Other	CMH NPI
WI	1326349135	Other	CMH SB NPI
WI	1376716746	Other	KRAUSE NPI
WI	52Z310	Medicare Oscar/Certification
WI	00439	Medicare PIN