Healthcare Provider Details

I. General information

NPI: 1356083612
Provider Name (Legal Business Name): GUNDERSEN LUTHERAN MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 SOUTH AVE
LA CROSSE WI
54601-5467
US

IV. Provider business mailing address

1910 SOUTH AVE
LA CROSSE WI
54601-5467
US

V. Phone/Fax

Practice location:
  • Phone: 608-782-7300
  • Fax:
Mailing address:
  • Phone: 608-782-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: GERALD P OETZEL
Title or Position: CFO
Credential:
Phone: 608-775-7914