Healthcare Provider Details

I. General information

NPI: 1093429821
Provider Name (Legal Business Name): CUMBERLAND MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2023
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 16TH AVE
CUMBERLAND WI
54829
US

IV. Provider business mailing address

1705 16TH AVE
CUMBERLAND WI
54829-8601
US

V. Phone/Fax

Practice location:
  • Phone: 715-822-7548
  • Fax: 715-822-7111
Mailing address:
  • Phone: 715-822-7222
  • Fax: 715-822-7111

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: EMILY DILLEY
Title or Position: CEO
Credential:
Phone: 715-822-7252