MEDICARE: GUNDERSEN CLINIC, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1013137660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUNDERSEN CLINIC, LTD.

Provider Business Mailing Address
First Line	:	1836 SOUTH AVE
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-5429
Country	:	US
Telephone Number	:	608-782-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 PEEBLES DR
Second Line	:
City	:	RICHLAND CENTER
State	:	WI
Zip	:	53581-2940
Country	:	US
Telephone Number	:	608-782-7300
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. COLETTE M LASACK
Credential	:
Telephone Number	:	608-782-7300

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	08/22/2020

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