=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346239373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEMORIAL HOSPITAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2005
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N3708 RIVER AVE
-----------------------------------------------------
City | NEILLSVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54456-7218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-743-3101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N3708 RIVER AVE
-----------------------------------------------------
City | NEILLSVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54456-7218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-743-3101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO, AO
-----------------------------------------------------
Name | KATHLEEN A BRESSLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 715-975-6018
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------