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General NPI Number Information
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NPI Number | 1376593442
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Entity Type | Organization
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Legal Business Name | GUNDERSEN LUTHERAN MEDICAL CENTER INC
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 1910 SOUTH AVE
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City | LA CROSSE
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State | WI
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Zip | 54601
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Country | US
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Telephone | 608-775-4370
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Fax | 608-775-7440
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Provider Business Mailing Address
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Address Line | 1910 SOUTH AVE
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City | LA CROSSE
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State | WI
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Zip | 54601-5467
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Country | US
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Telephone | 608-782-7300
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Fax |
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Authorized Official
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Title or Position | CCO
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Name | KARI B ADANK
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Credential |
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Telephone | 608-775-8025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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