1861829194 NPI number — MOUNDVIEW MEMORIAL HOSPITAL & CLINICS, INC.

Table of content: (NPI 1861829194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861829194 NPI number — MOUNDVIEW MEMORIAL HOSPITAL & CLINICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNDVIEW MEMORIAL HOSPITAL & CLINICS, 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:
1861829194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 W LAKE ST
Provider Second Line Business Mailing Address:
PO BOX 40
Provider Business Mailing Address City Name:
FRIENDSHIP
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53934-9699
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-339-3331
Provider Business Mailing Address Fax Number:
608-339-9385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 N PIONEER PARK RD
Provider Second Line Business Practice Location Address:
UNIT 8
Provider Business Practice Location Address City Name:
WESTFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53964-9092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-296-6350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ-GUERRA
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
608-339-6814

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  107800 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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