1093763518 NPI number — AMERY REGIONAL MEDICAL CENTER, INC

Table of content: ELISE ANNE JOHNSON MD (NPI 1073373205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093763518 NPI number — AMERY REGIONAL MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERY REGIONAL MEDICAL CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093763518
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
265 GRIFFIN ST E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMERY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54001-1439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-268-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
265 GRIFFIN ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMERY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54001-1439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-268-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUDQUIST
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
715-268-8000

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 49170 . This is a "MEDICARE PROVIDER GROUP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 521308 . This is a "MEDICARE CAH#" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1093763518 . This is a "LUCK PHYSICAL THERAPY & FITNESS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11007610 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32947300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32862100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21177 . This is a "ANESTHESIA GROUP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 41228200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: MEDICARE IP 52M308 . This is a "ARMC BEHAVIORAL HEALTH CENTER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 00496 . This is a "MEDICARE PROVIDER GROUP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 52Z308 . This is a "MEDICARE SWING BED" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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