MEDICARE: AMERY REGIONAL MEDICAL CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center		WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	528561	OTHER	WI	RURAL HEALTH CLINIC
2	1861552010	OTHER	WI	CARLA VOSSEN NP
3	52DD397211	OTHER		CLIA
4	1720050909	OTHER	WI	VERONICA MINIER, MD

General Provider Information

NPI Number	:	1538384466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERY REGIONAL MEDICAL CENTER, INC

Provider Business Mailing Address
First Line	:	265 GRIFFIN ST E
Second Line	:	AMERY REGIONAL MEDICAL CENTER
City	:	AMERY
State	:	WI
Zip	:	54001-1439
Country	:	US
Telephone Number	:	715-268-8000
Fax Number	:	715-268-0311

Provider Business Practice Location Address
First Line	:	550 MARTIN AVE W
Second Line	:	TURTLE LAKE MEDICAL CLINIC
City	:	TURTLE LAKE
State	:	WI
Zip	:	54889-9069
Country	:	US
Telephone Number	:	715-986-4101
Fax Number	:	715-986-4033

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DEBRA A RUDQUIST
Credential	:	FACHE
Telephone Number	:	715-268-8000

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	04/10/2015

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