Healthcare Provider Details

I. General information

NPI: 1801270962
Provider Name (Legal Business Name): MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 E ELM DR
LOYAL WI
54446-9604
US

IV. Provider business mailing address

216 SUNSET PL
NEILLSVILLE WI
54456-1706
US

V. Phone/Fax

Practice location:
  • Phone: 715-255-8551
  • Fax: 715-743-8022
Mailing address:
  • Phone: 715-743-3101
  • Fax: 715-743-8022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number641-23
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateWI

VIII. Authorized Official

Name: RYAN T NEVILLE
Title or Position: CEO
Credential:
Phone: 715-743-8449