Basic Information
| Provider Information | |||||||||
| NPI: | 1336435585 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOLY FAMILY MEMORIAL INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HFM RHEUMATOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2290 | ||||||||
| Address2: | |||||||||
| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542212290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203202591 | ||||||||
| FaxNumber: | 9203204155 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 S 41ST ST | ||||||||
| Address2: | |||||||||
| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542207316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203204500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2011 | ||||||||
| LastUpdateDate: | 06/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | RAUBER | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR HEALTH INFORMATION MGMT | ||||||||
| AuthorizedOfficialTelephone: | 9203203444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HOLY FAMILY MEMORIAL INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.