Healthcare Provider Details

I. General information

NPI: 1043494859
Provider Name (Legal Business Name): AMERY REGIONAL MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 02/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 GRIFFIN ST E
AMERY WI
54001-1439
US

IV. Provider business mailing address

265 GRIFFIN ST E
AMERY WI
54001-1439
US

V. Phone/Fax

Practice location:
  • Phone: 715-268-0670
  • Fax: 715-268-0673
Mailing address:
  • Phone: 715-268-0670
  • Fax: 715-268-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number8785
License Number StateWI

VIII. Authorized Official

Name: MR. MARK A TRYGGESTAD
Title or Position: DIRECTOR OF PHARMACY
Credential: RPH
Phone: 715-268-0670