Healthcare Provider Details

I. General information

NPI: 1083621015
Provider Name (Legal Business Name): AMERY REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 06/20/2016
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

PO BOX 452
AMERY WI
54001-0452
US

V. Phone/Fax

Practice location:
  • Phone: 715-268-0678
  • Fax: 715-268-0679
Mailing address:
  • Phone: 715-268-0678
  • Fax: 715-268-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8784-42
License Number StateWI

VIII. Authorized Official

Name: MATTHEW JOHNSON
Title or Position: OWNER
Credential: RPH
Phone: 715-268-8121