Healthcare Provider Details

I. General information

NPI: 1932124898
Provider Name (Legal Business Name): MILE BLUFF MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 VIEW ST
NEW LISBON WI
53950-1079
US

IV. Provider business mailing address

1050 DIVISION ST
MAUSTON WI
53948-1931
US

V. Phone/Fax

Practice location:
  • Phone: 608-562-3667
  • Fax: 608-562-6590
Mailing address:
  • Phone: 608-847-6161
  • Fax: 608-562-6590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2367
License Number StateWI

VIII. Authorized Official

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