NPIMap

Organization Active NPI

Bellin Memorial Hospital, Inc.

Doing business as Bellin Health Outreach Laboratory

  • Clinical Medical Laboratory
  • Green Bay, WI
National Provider Identifier
1891937256
Registry record updated May 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
52D0662050 Issued in WI
Legal business name
BELLIN MEMORIAL HOSPITAL, INC.
Doing business as
Bellin Health Outreach Laboratory
Practice address
744 S Webster Ave
Green Bay, WI 54301-3505
Phone
(920) 433-7848
Fax
(920) 433-7878
NPI assigned
Apr 1, 2009
Last updated
May 18, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
BELLIN MEMORIAL HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 18, 2020

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

Authorized official

Name
Mrs. Denise K Stroobants
Title
Credentialing Specialist
Phone
(920) 445-7226

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 52D0662050 WI Primary
Clinical Medical Laboratory 291U00000X 52D0913169 WI

Addresses

Primary practice location

744 S Webster Ave
Green Bay, WI 54301-3505

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222

Other identifiers 4

IdentifierTypeStateIssuer
32947900MedicaidWI
52D0662050OtherWICLIA - CLINICAL LABORATORY IMPROVEMENT AMENDMENTS
52D0913169OtherWICLIA-CLINIC LABORATORY IMPROVEMENT AMENDMENTS
11010200MedicaidWI

Other names 1

  • Bellin Health Outreach Laboratory Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Womens Spec CR Marinett55 organizations share this tax ID, including this one
Part of
Womens Spec CR Marinett

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1238544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589760000000",
    "number": "1891937256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7222",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013505",
            "telephone_number": "920-433-7848",
            "fax_number": "920-433-7878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLIN MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BELLIN MEMORIAL HOSPITAL, INC.",
        "enumeration_date": "2009-04-01",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A",
        "authorized_official_last_name": "STROOBANTS",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "920-445-7226",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WI",
            "license": "52D0662050",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "WI",
            "license": "52D0913169",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32947900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA - CLINICAL LABORATORY IMPROVEMENT AMENDMENTS",
            "identifier": "52D0662050",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA-CLINIC LABORATORY IMPROVEMENT AMENDMENTS",
            "identifier": "52D0913169",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11010200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bellin Health Outreach Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.