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General NPI Number Information
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NPI Number | 1164433660
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Entity Type | Organization
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Legal Business Name | GUNDERSEN CLINIC, LTD.
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 724 DENTON ST
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City | LA CROSSE
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State | WI
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Zip | 54601-5447
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Country | US
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Telephone | 608-775-1000
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Fax | 608-775-1010
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Provider Business Mailing Address
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Address Line | 724 DENTON ST
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City | LA CROSSE
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State | WI
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Zip | 54601-5447
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Country | US
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Telephone | 608-775-1000
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Fax | 608-775-1010
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Authorized Official
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Title or Position | VP CROSS FUNCTION CARE
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Name | TINA LECHNIR
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Credential |
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Telephone | 608-775-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 8317042
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | 263512
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License Number State | MN
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