NPIMap

Organization Active NPI

County of Shawano

  • Community/Behavioral Health Agency
  • Shawano, WI
National Provider Identifier
1497896641
Registry record updated Dec 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
1831 Issued in WI
Legal business name
COUNTY OF SHAWANO
Practice address
504 Lakeland Rd
Shawano, WI 54166
Phone
(715) 526-5547
Fax
(715) 526-5542
NPI assigned
Feb 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Barbara Larson-Herber
Title
Executive Program Director
Phone
(715) 526-5547

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 1831 WI Primary

Addresses

Primary practice location

504 Lakeland Rd
Shawano, WI 54166

Mailing address

504 Lakeland Rd
Shawano, WI 54166
Phone (715) 526-5547

Other identifiers 1

IdentifierTypeStateIssuer
42132800MedicaidWI

Other names 1

  • Shawano County Department of Community Programs Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111227000666 WI Part B Supplier - Clinic/Group Practice 3779594874 Receives reassigned benefits from 8 practitioners
Practice locations: Shawano, WI

National Provider Directory

National Provider Directory
Tax ID family
Shawano County Pub HLTH11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

504 Lakeland Rd
Shawano, WI 54166
Phone (715) 526-4700

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323820800000",
    "number": "1497896641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 LAKELAND RD",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "54166",
            "telephone_number": "715-526-5547",
            "fax_number": "715-526-5542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 LAKELAND RD",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "54166",
            "telephone_number": "715-526-5547",
            "fax_number": "715-526-5542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SHAWANO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2011-12-14",
        "status": "A",
        "authorized_official_last_name": "LARSON-HERBER",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "EXECUTIVE PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "715-526-5547",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WI",
            "license": "1831",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42132800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shawano County Department of Community Programs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawano, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.