Healthcare Provider Details

I. General information

NPI: 1467560227
Provider Name (Legal Business Name): LADD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 65TH AVE
OSCEOLA WI
54020-4370
US

IV. Provider business mailing address

PO BOX 218
OSCEOLA WI
54020-0218
US

V. Phone/Fax

Practice location:
  • Phone: 715-294-2111
  • Fax: 715-294-5696
Mailing address:
  • Phone: 715-294-2111
  • Fax: 715-294-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number1021
License Number StateWI

VIII. Authorized Official

Name: KELLY ELIZABETH MACKEN-MARBLE
Title or Position: CEO
Credential:
Phone: 715-294-5622