1659709830 NPI number — PRAIRIE DU CHIEN MEMORIAL HOSPITAL ASSOC INC

Table of content: (NPI 1659709830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659709830 NPI number — PRAIRIE DU CHIEN MEMORIAL HOSPITAL ASSOC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRAIRIE DU CHIEN MEMORIAL HOSPITAL ASSOC 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:
1659709830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37822 US HIGHWAY 18
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRAIRIE DU CHIEN
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53821-8416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-357-2000
Provider Business Mailing Address Fax Number:
608-357-2254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37822 US HWY 18
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAIRIE DU CHIEN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53821-8416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-326-1072
Provider Business Practice Location Address Fax Number:
608-326-1076
Provider Enumeration Date:
10/24/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BROPHY
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
608-357-2000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  HSAT-7QXLRW , 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: 1619024197 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619024197 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".