Healthcare Provider Details

I. General information

NPI: 1518352921
Provider Name (Legal Business Name): VERNON MEMORIAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N. MILL ST.
LAFARGE WI
54639
US

IV. Provider business mailing address

407 S MAIN ST STE 104
VIROQUA WI
54665-4004
US

V. Phone/Fax

Practice location:
  • Phone: 608-625-2552
  • Fax: 608-625-2553
Mailing address:
  • Phone: 608-637-4718
  • Fax: 608-637-4719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9310-42
License Number StateWI

VIII. Authorized Official

Name: RAMONA FLORENE HANSON
Title or Position: PHARMACY BILLING
Credential:
Phone: 608-637-4718