NPIMap

Organization Active NPI

Prohealth Oconomowoc Memorial Hospital, Inc.

  • Institutional Pharmacy
  • Oconomowoc, WI
National Provider Identifier
1982797312
Registry record updated Dec 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
4758042 Issued in WI
Legal business name
PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL, INC.
Practice address
791 Summit Ave
Oconomowoc, WI 53066-3844
Phone
(262) 569-0471
Fax
(262) 569-0422
NPI assigned
Sep 30, 2006
Last updated
Dec 14, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2022

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

Authorized official

Name
Thomas W Johnson, RPH
Title
Reimbursement Manager
Phone
(262) 928-4704

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X 4758042 WI Primary

Addresses

Primary practice location

791 Summit Ave
Oconomowoc, WI 53066-3844

Mailing address

791 Summit Ave
Oconomowoc, WI 53066-3844
Phone (262) 569-0471

Other identifiers 1

IdentifierTypeStateIssuer
5108510OtherOTHER ID NUMBER-COMMERCIAL NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Mem Hosp of Oconomowoc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670976000000",
    "number": "1982797312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "791 SUMMIT AVE",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663844",
            "telephone_number": "262-569-0471",
            "fax_number": "262-569-0422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "791 SUMMIT AVE",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530663844",
            "telephone_number": "262-569-0471",
            "fax_number": "262-569-0422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-30",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "REIMBURSEMENT MANAGER",
        "authorized_official_telephone_number": "262-928-4704",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "WI",
            "license": "4758042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "5108510",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oconomowoc, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; 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.