Healthcare Provider Details

I. General information

NPI: 1104162841
Provider Name (Legal Business Name): MILE BLUFF MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2012
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W BRIDGE ST
NEW LISBON WI
53950-1083
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 TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number134
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number134
License Number StateWI

VIII. Authorized Official

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