Healthcare Provider Details

I. General information

NPI: 1447427505
Provider Name (Legal Business Name): VERNON MEMORIAL HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W STATE ST
WESTBY WI
54667-1254
US

IV. Provider business mailing address

115 W STATE ST
WESTBY WI
54667-1254
US

V. Phone/Fax

Practice location:
  • Phone: 608-634-2222
  • Fax: 608-634-2427
Mailing address:
  • Phone: 608-634-2222
  • Fax: 608-634-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number8815-42
License Number StateWI

VIII. Authorized Official

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