Langlade Hospital - Hotel Dieu of St. Joseph of Antigo Wisconsin
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Antigo, WI
NPI 1295870731 · NPPES record last updated Jun 13, 2024
Key facts
- NPI
- 1295870731
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- LANGLADE HOSPITAL - HOTEL DIEU OF ST. JOSEPH OF ANTIGO WISCONSIN
- Practice address
- 112 E 5TH Ave
Antigo, WI 54409-2710 - Phone
- (715) 626-2331
- NPI assigned
- Feb 21, 2007
- Organization subpart
- No
Authorized official
- Name
- Jerry M Yang
- Title
- SVP & Chief Financial Officer
- Phone
- (715) 847-2526
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 8
Practitioners 86
-
Alaina Below, FNP-BC
-
Angela Buchman, PA
-
Michael J Darr, ANP
-
Lakshmi Deep, MD
-
Noel N Deep, MD
-
Kyle Dembowiak, MD
-
Gregory G Dodge, MD
-
Kelly Jonathon Douck, CRNA
-
Melissa Ferg, CRNA
-
Samantha J Fox, APNP
-
Kara Hall, LCSW
-
Angela Haroldson, PMHNP
-
Sarah Kathryn Houdek, APNP
-
Hema Kamthamneni, M.D.
-
Jennifer J Lee, APNP
-
Nathaniel Joseph Retrum, PA-C
-
Calla J Scheel, APNP, PMHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111202000277 | WI | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 1557271202 | Practice locations: Antigo, WI |
National Provider Directory
- Tax ID family
- Langlade Memorial Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Yes |
Addresses
Primary practice location
112 E 5TH Ave
Antigo, WI 54409-2710
Mailing address
29980 Network PL
Chicago, IL 60673-1299
Phone (715) 847-2304
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42062400 | Medicaid | WI |
Other providers in Antigo, WI
- Krueger Chiropractic LLC
- Andrew Cary Krueger
- Hannah Elizabeth Krueger
- Langlade County
- Langlade Hospital - Hotel Dieu of St Joseph of Antigo Wisconsin
- Langlade Hospital - Hotel Dieu of St. Joseph of Antigo Wisconsin
- Langlade Hospital - Hotel Dieu of St. Joseph of Antigo Wisconsin
- Langlade Hospital - Hotel Dieu of St. Joseph of Antigo Wisconsin
- Langlade Hospital - Hotel Dieu of St. Joseph of Antigo Wisconsin
- Langlade Hospital - Hotel Dieu of St. Joseph of Antigo Wisconsin
All providers in Antigo, WI · End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.