Healthcare Provider Details

I. General information

NPI: 1447179965
Provider Name (Legal Business Name): LADD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21190 OZARK AVE N
SCANDIA MN
55073-4403
US

IV. Provider business mailing address

PO BOX 218
OSCEOLA WI
54020-0218
US

V. Phone/Fax

Practice location:
  • Phone: 651-461-4224
  • Fax:
Mailing address:
  • Phone: 651-461-4224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KELLY ELIZABETH MARBLE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 715-294-5622