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General NPI Number Information
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NPI Number | 1801394549
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Entity Type | Organization
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Legal Business Name | LADD MEMORIAL HOSPITAL
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 2600 65TH AVE
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City | OSCEOLA
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State | WI
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Zip | 54020-4370
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Country | US
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Telephone | 715-294-2111
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Fax | 715-294-5758
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Provider Business Mailing Address
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Address Line | PO BOX 218
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City | OSCEOLA
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State | WI
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Zip | 54020-0218
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Country | US
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Telephone | 715-294-2111
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | KELLY ELIZABETH MACKEN-MARBLE
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Credential |
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Telephone | 715-294-5622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 1021
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License Number State | WI
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