COMMUNITY MEMORIAL HOSPITAL, INCORPORATED (NPI# 1093096224) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093096224 |
| Entity Type | Organization |
| Organization Name | COMMUNITY MEMORIAL HOSPITAL, INCORPORATED |
| Other Organization Name | D/B/A BREAST SURGERY EXPERTS OF NORTHEAST WISCONSIN LLC |
| Practice Address |
1726 Shawano Ave Green Bay WI 54303-3216 |
| Mailing Address |
25630 Network Pl Chicago IL 60673-1256 |
| Practice Telephone | 9203603787 |
| Practice Fax Number | 8888480225 |
| Mailing Telephone | 9203603787 |
| Mailing Fax Number | 8888480225 |
| Enumeration Date | 2011-09-01 |
| Last Update Date | 2012-01-13 |
| Authorized Official Name | DANIEL DEGROOT (CEO) |
| Authorized Official Telephone | 9208463444 |
| Is Organization Subpart | Y |
| Parent Organization Name | COMMUNITY MEMORIAL HOSPITAL, INCORPORATED |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 39597-20 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | PROVIDER | 1750302089 | 01 |
| WI | MEDICARE PTAN | WI2552 | 01 |
| WI | CMH NPI | 1851477913 | 01 |
| Other Name | Type Code |
|---|---|
| d/b/a Breast Surgery Experts of Northeast Wisconsin LLC | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386925915 | Community Memorial Hospital, Incorporated | Surgery | 835 S Main St, Oconto Falls, WI 54154-1282 | 2011-09-09 |
| 1801177035 | Community Memorial Hospital, Incorporated | Surgery | 200 Theda Clark Medical Plz, Suite 210, Neenah, WI 54956-2721 | 2011-09-01 |
| 1437470572 | Community Memorial Hospital, Incorporated | Physical Therapist | 103 1st St, Oconto, WI 54153-1117 | 2010-06-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | COMMUNITY MEMORIAL HOSPITAL, INCORPORATED | 800 Memorial Dr Ste 1, Spring Valley, MN 55975-1055 |
| Street Address |
1726 SHAWANO AVE |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303-3216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356324990 | Thomas M. Farley | Anesthesiology | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2005-11-29 |
| 1265048805 | Hillary Ann Bashaw | Nurse Practitioner | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2020-09-18 |
| 1043828387 | St Mary's Hospital Medical Center of Green Bay Inc.-hospital Sisters | Clinical Medical Laboratory | 1726 Shawano Ave, Green Bay, WI 54303-3282 | 2020-07-22 |
| 1750930079 | Jenna Mae Spude | Nurse Practitioner | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2019-09-09 |
| 1215423504 | Matthew James Dolan | Physician Assistant | 1726 Shawano Ave, Green Bay, WI 54303 | 2018-07-10 |
| 1013430073 | Whitney Jo Brusich | Physician Assistant | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2017-07-21 |
| 1720510043 | Christina R Mestelle | Physical Therapist | 1726 Shawano Ave, Green Bay, WI 54303 | 2017-03-28 |
| 1407231178 | Ahmed Farouk Mohammed | Internal Medicine | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2015-07-23 |
| 1184004236 | St. Vincent Hospital-hospital Sisters-third Order of St. Francis | Internal Medicine | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2015-06-04 |
| 1629468343 | Lynn Wilson | Nurse Practitioner | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2015-02-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952921033 | Ashley Marie Vandermoss | Social Worker | 1601 W Mason Street, Green Bay, WI 54303 | 2020-04-20 |
| 1598307423 | Jean Marie Castaneda | Case Manager/Care Coordinator | 2517 N. Court, Green Bay, WI 54303 | 2019-10-11 |
| 1215579552 | Integrated Treatment Centers, LLC | Clinic/Center | 2311 W Mason Street, Green Bay, WI 54303 | 2019-10-08 |
| 1003460551 | Affordable Dentures & Implants - Green Bay, S.c. | Dentist | 1800-c W. Mason Street, Green Bay, WI 54303 | 2019-08-01 |
| 1164940375 | Kaeley Rae Blaney | Student in an Organized Health Care Education/Training Program | 2088 Memorial Drive #208, Green Bay, WI 54303 | 2017-09-07 |
| 1518498047 | Treatment Providers LLC | Clinic/Center | 2731 N Packerland Dr Ste A, Green Bay, WI 54303 | 2017-03-26 |
| 1851840565 | Back To Balance Chiropractic, LLC | Chiropractor | 110 Packerland Drive, Suite B, Green Bay, WI 54303 | 2016-09-23 |
| 1710361001 | Matthew Lemay | Acupuncturist | 727 E Walnut, Suite B2, Green Bay, WI 54303 | 2015-07-16 |
| 1144600149 | Carrie Jean Banaszak | Counselor | 1039 Mason Street, Green Bay, WI 54303 | 2015-06-04 |
| 1174921993 | Kensey Meyer | Occupational Therapy Assistant | 1555 Dousman Road, Seymour, WI 54303 | 2014-12-10 |
| Find all providers in zip 54303 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598885303 | Sursum Corda, Sc | Surgery | 900 S. Webster Avenue, Green Bay, WI 54301 | 2007-03-29 |
| 1891808671 | New Surgical Associates Sc | Surgery | 670 Cormier Rd, Green Bay, WI 54304-4824 | 2006-08-16 |
| 1255389755 | Daniel T. Mckenna | Surgery | 2845 Greenbrier Rd Ste 230, Green Bay, WI 54311-6519 | 2006-05-05 |
| 1679531529 | Gope C Hotchandani | Surgery | 2771 Ramada Way, Green Bay, WI 54304-5759 | 2006-05-02 |
| 1265435853 | Cynthia L Geocaris | Surgery | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2005-05-27 |
| 1093173791 | St. Clare Memorial Hospital, Inc. | Surgery | 900 S Webster Ave, Green Bay, WI 54301-3508 | 2016-02-09 |
| 1184038978 | Daniel Joseph Budreau | Surgery | 2845 Greenbrier Rd, Green Bay, WI 54311-6519 | 2014-06-19 |
| 1174934806 | Humera Fatima Ahmad | Surgery | 1715 Dousman St, Green Bay, WI 54303-3211 | 2014-05-15 |
| 1104263532 | Bellin Memorial Hospital Inc | Surgery | 720 S Vanburen St, Suite 201, Green Bay, WI 54301-3534 | 2013-05-24 |
| 1689010118 | Nicholas Edward Coorough | Surgery | 720 S Vanburen St, Suite 201, Green Bay, WI 54301-3534 | 2013-05-10 |
| Find all providers in GREEN BAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.