Healthcare Provider Details

I. General information

NPI: 1679746747
Provider Name (Legal Business Name): MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SUNSET PL MEMORIAL HOSPITAL, INC
NEILLSVILLE WI
54456-1706
US

IV. Provider business mailing address

216 SUNSET PL MEMORIAL HOSPITAL, INC
NEILLSVILLE WI
54456-1706
US

V. Phone/Fax

Practice location:
  • Phone: 715-743-3101
  • Fax: 715-743-6245
Mailing address:
  • Phone: 715-743-3101
  • Fax: 715-743-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateWI

VIII. Authorized Official

Name: MR. SCOTT POLENZ
Title or Position: ADMINISTRATOR
Credential: CEO
Phone: 715-743-3101