1144487372 NPI number — REEDSBURG AREA MEDICAL CENTER

Table of content: MELISSA CHRISTINE BYRNE LADAC1 (NPI 1386343739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144487372 NPI number — REEDSBURG AREA MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REEDSBURG AREA MEDICAL CENTER
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:
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:
1144487372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 N DEWEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REEDSBURG
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53959-1049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-524-6487
Provider Business Mailing Address Fax Number:
608-524-0842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 N DEWEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REEDSBURG
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53959-1049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-524-6487
Provider Business Practice Location Address Fax Number:
608-524-0842
Provider Enumeration Date:
05/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VANMEETEREN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
608-524-6487

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  1057 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41172100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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