Healthcare Provider Details

I. General information

NPI: 1255620613
Provider Name (Legal Business Name): MEMORIAL HOSPITAL OF BOSCOBEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N WISCONSIN AVE
MUSCODA WI
53573-9251
US

IV. Provider business mailing address

205 PARKER ST
BOSCOBEL WI
53805-1642
US

V. Phone/Fax

Practice location:
  • Phone: 608-375-4112
  • Fax:
Mailing address:
  • Phone: 608-375-4112
  • Fax:

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: THERESA BRAUDT
Title or Position: DIRECTOR OF NURSING
Credential:
Phone: 608-375-6203