Healthcare Provider Details

I. General information

NPI: 1184841561
Provider Name (Legal Business Name): LADD MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RIVER ST.
OSCEOLA WI
54020
US

IV. Provider business mailing address

PO BOX 218
OSCEOLA WI
54020-0218
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number1021
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATT FORGE
Title or Position: CEO AND ADMINISTRATOR
Credential:
Phone: 715-294-5622