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General NPI Number Information
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NPI Number | 1013748060
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY MEMORIAL HOSPITAL INC
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Dates
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Enumeration Date | 08/12/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 250 STATE ROAD 37
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City | MONDOVI
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State | WI
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Zip | 54755-2611
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Country | US
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Telephone | 715-538-4361
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Fax |
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Provider Business Mailing Address
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Address Line | 18601 LINCOLN ST
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City | WHITEHALL
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State | WI
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Zip | 54773-8605
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Country | US
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Telephone | 715-538-4361
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DAN D COENEN
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Credential |
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Telephone | 715-538-4361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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