1376593442 NPI number — GUNDERSEN LUTHERAN MEDICAL CENTER INC

Table of content: (NPI 1376593442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376593442 NPI number — GUNDERSEN LUTHERAN MEDICAL CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUNDERSEN LUTHERAN 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:
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:
1376593442
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1910 SOUTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CROSSE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54601-5467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-782-7300
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1910 SOUTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-775-4370
Provider Business Practice Location Address Fax Number:
608-775-7440
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADANK
Authorized Official First Name:
KARI
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CCO
Authorized Official Telephone Number:
608-775-8025

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 11012926 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32945900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 33072600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 419555800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42194300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42220300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42228900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 169555000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42051000 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0699017 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11012900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100020154 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42050900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42063400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 765347600 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42053600 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42150400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42212400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44003500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110819700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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