Healthcare Provider Details

I. General information

NPI: 1780780171
Provider Name (Legal Business Name): BETHANY ST JOSEPH CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 SHELBY RD
LA CROSSE WI
54601-8037
US

IV. Provider business mailing address

2501 SHELBY RD
LA CROSSE WI
54601-8037
US

V. Phone/Fax

Practice location:
  • Phone: 608-788-5700
  • Fax: 608-788-4030
Mailing address:
  • Phone: 608-788-5700
  • Fax: 608-788-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. BECKY GROSSKOPF
Title or Position: BUSINESS OFFICE ASSISTANT
Credential:
Phone: 608-788-5700