Healthcare Provider Details

I. General information

NPI: 1144226507
Provider Name (Legal Business Name): VERNON MEMORIAL HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S MAIN ST SUITE 400
VIROQUA WI
54665-1511
US

IV. Provider business mailing address

407 S MAIN ST STE 400
VIROQUA WI
54665-4000
US

V. Phone/Fax

Practice location:
  • Phone: 608-637-3174
  • Fax: 608-637-3120
Mailing address:
  • Phone: 608-637-3174
  • Fax: 608-638-5038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID HARTBERG
Title or Position: CEO
Credential:
Phone: 608-637-4796