COMMUNITY MEMORIAL HOSPITAL (NPI# 1407186141) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407186141 |
| Entity Type | Organization |
| Organization Name | COMMUNITY MEMORIAL HOSPITAL |
| Other Organization Name | CMH PRIMARY CARE CLINIC, REMOTE DISPENSING REGISTRATION |
| Practice Address |
340 N Green Bay Ave Gillett WI 54124-9325 |
| Practice Telephone | 9208552823 |
| Practice Fax Number | 9208556343 |
| Mailing Telephone | 9208552823 |
| Mailing Fax Number | 9208556343 |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2009-12-31 |
| Authorized Official Name | MR. JASON E KNOX (PHARMACY MANAGER) |
| Authorized Official Telephone | 9208463444 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| DEA REGISTRATION NUMBER | FC1283744 | 01 |
| Other Name | Type Code |
|---|---|
| CMH Primary Care Clinic, Remote Dispensing Registration | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336632280 | Community Memorial Hospital | Clinic/Center | 104 S. West Street, Edgerton, OH 43517 | 2018-06-14 |
| 1528208162 | Community Memorial Hospital | Family Medicine | 100 West 4th St, Montrose, MO 64770 | 2009-02-23 |
| 1689842478 | Community Memorial Hospital | Clinic/Center | 122 2nd St. East, Mcclusky, ND 58463-0618 | 2008-02-14 |
| 1598945867 | Community Memorial Hospital | Clinic/Center | 101 Giesler Dr, Osceola, MO 64776-6297 | 2007-11-05 |
| 1730145392 | Community Memorial Hospital | Clinic/Center | 208 Columbus Street, Hicksville, OH 43526 | 2006-04-24 |
| 1336103738 | Community Memorial Hospital | General Acute Care Hospital | 1755 N Mecklenburg Avenue, South Hill, VA 23970-1431 | 2006-04-13 |
| 1780150110 | Community Memorial Hospital | Clinic/Center | 107 Buffalo St, Antwerp, OH 45813-8434 | 2018-10-24 |
| 1164915021 | Community Memorial Hospital | Clinic/Center | 208 Columbus St, Hicksville, OH 43526-1250 | 2018-06-14 |
| 1891288866 | Community Memorial Hospital | Clinic/Center | 422 W River St, Antwerp, OH 45813-8417 | 2018-06-13 |
| 1609303692 | Community Memorial Hospital | Family Medicine | 164 Broad St, Hamilton, NY 13346-9575 | 2017-05-22 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | COMMUNITY MEMORIAL HOSPITAL | 809 Jackson St, Burke, SD 57523-2065 |
| Virginia Business Entities | Community Memorial Hospital | 1755 N Mecklenburg Ave, P. O. Box 90, South Hill, Virginia 23970-4080 |
| System for Award Management (SAM) Entities | COMMUNITY MEMORIAL HOSPITAL ASSOCIATION | 400 Caldwell St, Staunton, IL 62088-1173 |
| Virginia Business Entities | Community Memorial Hospital Foundation | 1755 N Mecklenburg Ave, South Hill, Virginia 23970-4080 |
| New York State Corporations | COMMUNITY MEMORIAL HOSPITAL FOUNDATION, INC. | 150 Broad St., Hamilton, Ny 13346 |
| System for Award Management (SAM) Entities | COMMUNITY MEMORIAL HOSPITAL, INC. | 2731 Healthcare Dr, Syracuse, NE 68446-7880 |
| System for Award Management (SAM) Entities | COMMUNITY MEMORIAL HOSPITAL, INCORPORATED | 800 Memorial Dr Ste 1, Spring Valley, MN 55975-1055 |
| Street Address |
340 N GREEN BAY AVE |
| City | GILLETT |
| State | WI |
| Zip Code | 54124-9325 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477540888 | Michele Ann Laduron | Nurse Practitioner | 340 N Green Bay Ave, Suite 1, Gillett, WI 54124-9325 | 2005-09-30 |
| 1972166981 | St Vincent Hospital-hospital Sisters-third Order of St Francis | Clinic/Center | 340 N Green Bay Ave, Gillett, WI 54124-9325 | 2019-04-16 |
| 1700107844 | St Clare Memorial Hospital, Inc | Physical Therapist | 340 N Green Bay Ave, Gillett, WI 54124-9325 | 2010-06-11 |
| 1962622522 | The Caring Doctor, LLC | Family Medicine | 340 N Green Bay Ave, Gillett, WI 54124-9325 | 2007-04-26 |
| 1134250905 | St Clare Memorial Hospital, Inc | Nurse Practitioner | 340 N Green Bay Ave, Gillett, WI 54124-9325 | 2007-03-07 |
| 1780616896 | Yu Chin Fang | Family Medicine | 340 N Green Bay Ave, Gillett, WI 54124-9325 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699956607 | Cooperative Educational Service Agency No 8 | Counselor | 223 W Park Street, Gillett, WI 54124 | 2007-11-19 |
| 1972556819 | Gillett Area Ambulance Service Inc. | Ambulance | 100 W Main St, Gillett, WI 54124-9002 | 2006-05-19 |
| 1710225693 | St Clare Memorial Hospital Inc | Pharmacy | 117 N Mckenzie St, Gillett, WI 54124-9142 | 2013-01-28 |
| 1689670549 | Woodlands of Gillett, Inc. | Skilled Nursing Facility | 330 Robin Hood Ln, Gillett, WI 54124-9201 | 2005-06-24 |
| 1366710063 | Jennifer Marie Clements | Physical Therapy Assistant | 330 Robin Hood Ln, Gillett, WI 54124-9201 | 2011-12-08 |
| 1427237056 | Gillett School District | Local Education Agency (LEA) | 208 W Main St, Gillett, WI 54124-9371 | 2007-10-31 |
| 1811993462 | Steven P Drake | Optometrist | 130 E Main St, Gillett, WI 54124-9386 | 2005-06-27 |
| 1639583610 | Evelyn Katrina Hauser-frederick | Dentist | 137 E Main St, Gillett, WI 54124-9386 | 2014-06-17 |
| 1528332947 | Hearing Professionals of America LLC | Hearing Aid Equipment | 130 E Main St, Gillett, WI 54124-9386 | 2012-03-02 |
| 1356554851 | Gillett Dental Care, S.c. | Dentist | 137 E Main St, Gillett, WI 54124-9386 | 2007-05-08 |
| Find all providers in zip 54124 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477188100 | Froedtert & The Medical College of Wisconsin Community Physicians Inc | Non-Pharmacy Dispensing Site | 635 S 28th St, Milwaukee, WI 53215-1201 | 2020-03-03 |
| 1841845385 | Planned Parenthood of Wisconsin | Non-Pharmacy Dispensing Site | 223 South Main St., Blair, WI 54616 | 2019-08-01 |
| 1982258737 | Planned Parenthood of Wisconsin | Non-Pharmacy Dispensing Site | 919 Hoeschler Dr Ste 100, Sparta, WI 54656-2202 | 2019-07-30 |
| 1780142992 | Froedtert & The Medical College of Wisconsin Community Physicians | Non-Pharmacy Dispensing Site | 11040 N Range Line Rd, Mequon, WI 53092-4930 | 2019-03-06 |
| 1992284087 | Froedtert & The Medical College of Wisconsin Community Physicians | Non-Pharmacy Dispensing Site | 4859 South 60th Street, Greenfield, WI 53220 | 2018-08-09 |
| 1801373378 | Froedtert & The Medical College of Wisconsin Community Physicians | Non-Pharmacy Dispensing Site | 1721 W Canal St, Milwaukee, WI 53233 | 2018-07-26 |
| 1205355500 | Froedtert Health | Non-Pharmacy Dispensing Site | 4850 S 60th St, Greenfield, WI 53220-4616 | 2017-09-18 |
| 1790071637 | St Mary's Hospital Medical Center | Non-Pharmacy Dispensing Site | 2840 Okeeffe Ave, Sun Prairie, WI 53590-7077 | 2011-06-20 |
| 1629390729 | Jt Medical Services, Inc. | Non-Pharmacy Dispensing Site | 12855 West Lisbon Road, 2nd Floor, Brookfield, WI 53005 | 2010-02-17 |
| 1013243294 | Barron County Office On Aging | Non-Pharmacy Dispensing Site | 335 E. Monroe Avenue, Room 112, Barron, WI 54812-1478 | 2009-10-23 |
| Find all providers with the same taxonomy | ||||
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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.