COMMUNITY MEMORIAL HOSPITAL, INCORPORATED (NPI# 1801177035) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801177035 |
| Entity Type | Organization |
| Organization Name | COMMUNITY MEMORIAL HOSPITAL, INCORPORATED |
| Other Organization Name | D/B/A BREAST SURGERY EXPERTS OF NORTHEAST WISCONSIN |
| Practice Address |
200 Theda Clark Medical Plz Suite 210 Neenah WI 54956-2721 |
| 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 DE GROOT (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 | MEDICARE PTAN | WI2553 | 01 |
| WI | PROVIDER | 1750302089 | 01 |
| WI | CMH NPI | 1851477913 | 01 |
| Other Name | Type Code |
|---|---|
| d/b/a Breast Surgery Experts of Northeast Wisconsin | 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 |
| 1093096224 | Community Memorial Hospital, Incorporated | Surgery | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 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 |
200 THEDA CLARK MEDICAL PLZ SUITE 210 |
| City | NEENAH |
| State | WI |
| Zip Code | 54956-2721 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992700918 | Marley L. Kercher | Obstetrics & Gynecology | 200 Theda Clark Medical Plz, Ste 130, Neenah, WI 54956-2790 | 2005-06-16 |
| 1427665504 | Hillary Rollins | Nurse Anesthetist, Certified Registered | 200 Theda Clark Medical Plz, Neenah, WI 54956-2721 | 2020-09-23 |
| 1417346149 | Kristy Hager | Registered Nurse | 200 Theda Clark Medical Plz, Suite 130, Neenah, WI 54956-2721 | 2015-01-19 |
| 1043503360 | Angela F Behm | Specialist/Technologist, Other | 200 Theda Clark Medical Plz, Suite 130, Neenah, WI 54956-2721 | 2011-05-19 |
| 1184916058 | Teena Rae Lutz | Specialist/Technologist, Other | 200 Theda Clark Medical Plz, Suite 130, Neenah, WI 54956-2721 | 2011-05-10 |
| 1255565701 | Maria Kristin Vandenberg | Obstetrics & Gynecology | 200 Theda Clark Medical Plz, Suite 130, Neenah, WI 54956-2721 | 2009-05-13 |
| 1124217963 | Jill Elizabeth Ziolkowski | Registered Nurse | 200 Theda Clark Medical Plz, Ste 350, Neenah, WI 54956-2721 | 2007-10-17 |
| 1518162247 | Benjamin John Ernst | Ophthalmology | 200 Theda Clark Medical Plz, Suite 110, Neenah, WI 54956-2721 | 2007-06-21 |
| 1679602510 | Tina S Ramsey | Obstetrics & Gynecology | 200 Theda Clark Medical Plz, Suite 270, Neenah, WI 54956-2721 | 2007-03-05 |
| 1922166511 | Robert A Nonn | Internal Medicine | 200 Theda Clark Medical Plz, Suite 480, Neenah, WI 54956-2721 | 2006-12-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447768411 | Wisconsin Institute of Surgical Excellence LLC | Clinic/Center | 1265 W American Dr Ste 200, Neenah, WI 54956 | 2018-01-12 |
| 1639614290 | Clinton Robert Murchland | Pharmacist | 828 Fox Point Plaza, Pharmacy, Neenah, WI 54956 | 2017-01-05 |
| 1629448550 | Melissa Christine Hewitt | Physical Therapy Assistant | 1119 Higgins Ave, Neenah, WI 54956 | 2015-10-05 |
| 1437581923 | Ross Phan | Pharmacist | 1432 Seymour Crt, Neenah, WI 54956 | 2013-08-06 |
| 1518201318 | Meridith Nealy Starling | Social Worker | 124 W Wisconsin Ave, Suite 90 B, Neenah, WI 54956 | 2012-11-16 |
| 1639464886 | Wisconsin Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 901 S. Green Bay Rd, Neenah, WI 54956 | 2011-06-16 |
| 1669701439 | Donna Jean Falk | Licensed Practical Nurse | 1037 B Hunt Ave, Neenah, WI 54956 | 2009-12-08 |
| 1285868257 | Angela Marie Bilbrey | Dietitian, Registered | 307 S Commercial St Ste 101, Neenah, WI 54956 | 2009-05-06 |
| 1003083114 | A B See Vision Therapy Centers Sc | Optometrist | 1401 Mcmahon Dr., Suite 100, Neenah, WI 54956 | 2008-05-08 |
| 1629244173 | Tamra Marie Knutson | Radiology | 333 N Commercial St #100, Neenah, WI 54956 | 2008-05-05 |
| Find all providers in zip 54956 | ||||
| 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 |
|---|---|---|---|---|
| 1700029212 | Sarah Beth Mingucci | Surgery | 130 2nd St Ste 197, Neenah, WI 54956-2883 | 2009-04-14 |
| 1154352078 | Kevin Francis Quinn | Surgery | 1147 Glenayre Dr, Neenah, WI 54956-4235 | 2006-07-06 |
| 1104876945 | Patrick James Brennan | Surgery | 100 Theda Clark Medical Plz, Suite 400, Neenah, WI 54956-2763 | 2006-05-11 |
| 1770810947 | Breast Surgery Experts of Northeast Wisconsin, LLC | Surgery | 130 2nd St, Neenah, WI 54956-2883 | 2009-11-10 |
| 1740469881 | Betsy R Winnekens | Surgery | 100 Theda Clark Medical Plz Ste 400, Neenah, WI 54956-2763 | 2007-10-25 |
| 1285792341 | Surgical Associates of Neenah, S.c. | Surgery | 130 2nd St, 100 Theda Clark Med Plaza, Suite 400, Neenah, WI 54956-2883 | 2006-12-04 |
| 1497705008 | Kevin Edward Wasco | Surgery | 100 Theda Clark Medical Plz, Suite 400, Neenah, WI 54956-2763 | 2006-05-12 |
| 1124078662 | Jeffrey Scott Burkett | Surgery | 100 Theda Clark Medical Plz, Suite 400, Neenah, WI 54956-2763 | 2006-05-12 |
| 1508817073 | David James Schultz | Surgery | 100 Theda Clark Medical Plz, Suite 400, Neenah, WI 54956-2763 | 2006-05-12 |
| 1881645364 | Nikhilesh Royopet Sekhar | Surgery | 100 Theda Clark Medical Plz, Suite 400, Neenah, WI 54956-2763 | 2006-05-12 |
| Find all providers in NEENAH | ||||
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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.