Provider Demographics
NPI:1780973826
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:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:WAUTOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54982-0650
Mailing Address - Country:US
Mailing Address - Phone:920-787-4613
Mailing Address - Fax:920-787-5433
Practice Address - Street 1:N2934 STATE ROAD 22
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-5267
Practice Address - Country:US
Practice Address - Phone:920-787-4613
Practice Address - Fax:920-787-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI25430207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11011000Medicaid
WI11011000Medicaid