Healthcare Provider Details

I. General information

NPI: 1467468173
Provider Name (Legal Business Name): GUNDERSEN LUTHERAN MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 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 Code3416A0800X
TaxonomyAir Ambulance
License Number6001336
License Number StateWI

VIII. Authorized Official

Name: KARI B ADANK
Title or Position: CCO
Credential:
Phone: 608-775-8025