Healthcare Provider Details

I. General information

NPI: 1598699365
Provider Name (Legal Business Name): TOMAH MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GOPHER DR
TOMAH WI
54660-4513
US

IV. Provider business mailing address

501 GOPHER DR
TOMAH WI
54660-4513
US

V. Phone/Fax

Practice location:
  • Phone: 608-372-2181
  • Fax:
Mailing address:
  • Phone: 608-372-2181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DEREK DALY
Title or Position: CEO
Credential:
Phone: 608-377-8680