Healthcare Provider Details

I. General information

NPI: 1497750921
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

507 S MAIN ST
VIROQUA WI
54665-2059
US

IV. Provider business mailing address

507 S MAIN ST
VIROQUA WI
54665-2059
US

V. Phone/Fax

Practice location:
  • Phone: 608-637-2101
  • Fax: 608-637-2141
Mailing address:
  • Phone: 608-637-2101
  • Fax: 608-637-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number1053
License Number StateWI

VIII. Authorized Official

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