Healthcare Provider Details

I. General information

NPI: 1710936893
Provider Name (Legal Business Name): PRAIRIE DU CHIEN MEMORIAL HOSPITAL ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37868 US HIGHWAY 18
PRAIRIE DU CHIEN WI
53821-8416
US

IV. Provider business mailing address

37868 US HIGHWAY 18
PRAIRIE DU CHIEN WI
53821-8416
US

V. Phone/Fax

Practice location:
  • Phone: 608-357-2000
  • Fax: 608-357-2254
Mailing address:
  • Phone: 608-357-2000
  • Fax: 608-357-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number1033
License Number StateWI

VIII. Authorized Official

Name: MR. CHRIS BROPHY
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 608-357-2000