STATE OF WISCONSIN (NPI# 1164516506) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164516506 |
| Entity Type | Organization |
| Organization Name | STATE OF WISCONSIN |
| Other Organization Name | WINNEBAGO MENTAL HEALTH INSTITUTE |
| Practice Address |
1300 South Drive Winnebago WI 54985-0009 |
| Practice Telephone | 9202354910 |
| Practice Fax Number | 9202372043 |
| Mailing Telephone | 9202354910 |
| Mailing Fax Number | 9202372043 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2008-02-15 |
| Authorized Official Name | ROBERT G KNEEPKENS (DIRECTOR) |
| Authorized Official Telephone | 9202354910 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 283Q00000X | Psychiatric Hospital | 250 | WI | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 10063000 | 05 |
| Other Name | Type Code |
|---|---|
| Winnebago Mental Health Institute | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558615815 | State of Wisconsin | Skilled Nursing Facility | 2175 E Park Ave, Chippewa Falls, WI 54729-3511 | 2012-11-07 |
| 1225152861 | State of Wisconsin | Skilled Nursing Facility | 21425g Spring St, Union Grove, WI 53182-9707 | 2007-03-19 |
| 1235225616 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 2820 East Park Avenue, Chippewa Falls, WI 54729-0340 | 2006-10-05 |
| 1366439986 | State of Wisconsin | Skilled Nursing Facility | N2665 County Road Qq, King, WI 54946 | 2005-09-29 |
| 1225362403 | State of Wisconsin | Durable Medical Equipment & Medical Supplies | 317 Knutson Dr, Madison, WI 53704-1133 | 2009-09-22 |
| 1336324946 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 317 Knutson Dr, Madison, WI 53704-1133 | 2008-01-02 |
| 1588703078 | State of Wisconsin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 317 Knutson Dr, Madison, WI 53704-1133 | 2007-02-05 |
| 1386705655 | State of Wisconsin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 317 Knutson Dr, Madison, WI 53704-1133 | 2006-12-12 |
| 1437253648 | State of Wisconsin | General Acute Care Hospital | 301 Troy Dr, Madison, WI 53704-1521 | 2006-09-08 |
| 1043326747 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 21425 Spring St, Union Grove, WI 53182-9707 | 2006-08-22 |
| Street Address |
1300 SOUTH DRIVE |
| City | WINNEBAGO |
| State | WI |
| Zip Code | 54985-0009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093702383 | Louis M Fulton | Psychiatry & Neurology | 1300 South Drive, Winnebago Mental Health Information, Winnebago, WI 54985-0009 | 2005-10-01 |
| 1225320005 | Konstantin A Mikheyev | Family Medicine | 1300 South Drive, Winnebago, WI 54985-0009 | 2011-05-11 |
| 1992028948 | Kaye Zwiacher | Psychiatry & Neurology | 1300 South Drive, Winnebago, WI 54985 | 2010-03-04 |
| 1417189135 | Kevin K Klein | Nurse Practitioner | 1300 South Drive, Winnebago, WI 54985-0009 | 2009-08-13 |
| 1669627089 | Anthony M Lichtfuss | Social Worker | 1300 South Drive, Winnebago, WI 54985 | 2008-11-26 |
| 1598984346 | Kayla M Pope | Psychiatry & Neurology | 1300 South Drive, Winnebago, WI 54985-0009 | 2007-04-24 |
| 1962626317 | Kent M Berney | Psychologist | 1300 South Drive, Winnebago, WI 54985-0009 | 2007-04-13 |
| 1255451688 | Clifford K Stephens | Psychologist | 1300 South Drive, Winnebago, WI 54985-0009 | 2007-03-30 |
| 1669505996 | Margaret Lehnert | Dentist | 1300 South Drive, Winnebago, WI 54985-0009 | 2007-03-14 |
| 1750425328 | Michele A. Andrade | Psychiatry & Neurology | 1300 South Drive, Winnebago, WI 54985 | 2007-02-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437315538 | Emerald M Hauser | Student in an Organized Health Care Education/Training Program | 1300 South Treffert Drive, Winnebago, WI 54985 | 2008-07-29 |
| 1427231828 | Carlo Gallo Gaanan | Family Medicine | 1505 North Drive, Winnebago, WI 54985 | 2007-12-10 |
| 1588781488 | Paul J Barfknecht | Pharmacist | 1300 South Dr, Winnebago, WI 54985 | 2007-03-23 |
| 1265924161 | Jeremiah Mobisa Gwaro | Nurse Practitioner | 1505 North Drive, Winnebago, WI 54985 | 2018-06-06 |
| 1932630985 | Thomas Michlowski | Psychiatry & Neurology | 1505 North Drive, Winnebago, WI 54985 | 2017-03-22 |
| 1295094571 | Julie Ann Thiel | Pharmacist | 1505 North Drive, Winnebago, WI 54985 | 2012-05-08 |
| 1124270947 | Adam Matthew Berman | Psychologist | 2901 W Kinnickinnic River Parkway, Ste 516 Medical Psychology Association, Milwaukee, WI 54985 | 2008-10-13 |
| 1225214802 | Dara B. Sitter | Pharmacist | 1300 South Dr., Winnebago, WI 54985 | 2008-01-14 |
| 1083825608 | Kelly Lee Straus-diedrick | Physical Therapist | 725 Butler Ave, Winnebago, WI 54985 | 2007-05-25 |
| 1093864993 | Byron J Krause | Speech-Language Pathologist | 725 Butler Ave, Oshkosh, WI 54985 | 2007-01-09 |
| Find all providers in zip 54985 | ||||
| Taxonomy Code | 283Q00000X |
| Grouping | Hospitals |
| Classification | Psychiatric Hospital |
| An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings. |
| Notes: Source: Expanded from Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003413816 | Sbh-madison LLC | Psychiatric Hospital | 3169 Deming Way, Middleton, WI 53562-1435 | 2020-10-05 |
| 1164736021 | Andrew Jay Kessler | Psychiatric Hospital | 1west Lincoln Avenue, Waupun, WI 53595 | 2010-08-03 |
| 1801908975 | County of Brown | Psychiatric Hospital | 3150 Gershwin Drive, Green Bay, WI 54311-5859 | 2006-08-31 |
| 1083728612 | County of Milwaukee | Psychiatric Hospital | 9455 W Watertown Plank Rd, Milwaukee, WI 53226-3559 | 2006-08-19 |
| 1205292869 | Veteran Health Administration | Psychiatric Hospital | 2500 Overlook Ter, Madison, WI 53705-2254 | 2016-01-12 |
| 1013212810 | Milwaukee County Behavioral Health | Psychiatric Hospital | 9201 W Watertown Plank Rd, Milwaukee, WI 53226-3558 | 2011-01-26 |
| 1104139021 | Wfhc - All Saints | Psychiatric Hospital | 1320 Wisconsin Ave, Racine, WI 53403-1978 | 2010-07-20 |
| 1053588293 | Joanne Zimmerman | Psychiatric Hospital | 9455 W Watertown Plank Rd, Milwaukee, WI 53226-3559 | 2008-05-15 |
| 1407988892 | County of Waukesha Department of Finance | Psychiatric Hospital | 1501 Airport Rd, Waukesha, WI 53188-3632 | 2007-03-12 |
| 1114035458 | Human Services Board Serving North Central Health Care | Psychiatric Hospital | 1100 Lake View Dr, Wausau, WI 54403-6785 | 2006-08-28 |
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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.