Healthcare Provider Details

I. General information

NPI: 1750387221
Provider Name (Legal Business Name): VERNON MEMORIAL HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 NORTH MILL STREET
LA FARGE WI
54639-6601
US

IV. Provider business mailing address

206 NORTH MILL STREET
LA FARGE WI
54639-6601
US

V. Phone/Fax

Practice location:
  • Phone: 608-625-2494
  • Fax: 608-638-5011
Mailing address:
  • Phone: 608-625-2494
  • Fax: 608-638-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID HARTBERG
Title or Position: CEO
Credential:
Phone: 608-637-4796