Healthcare Provider Details

I. General information

NPI: 1609912005
Provider Name (Legal Business Name): MILE BLUFF MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 DIVISION ST
MAUSTON WI
53948-1931
US

IV. Provider business mailing address

1050 DIVISION ST
MAUSTON WI
53948-1931
US

V. Phone/Fax

Practice location:
  • Phone: 608-847-6161
  • Fax: 608-847-2079
Mailing address:
  • Phone: 608-847-6161
  • Fax: 608-847-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: THOMAS KAMINSKI
Title or Position: VP/CFO
Credential:
Phone: 608-847-1452