MEDICARE: MILE BLUFF MEDICAL CENTER INC

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	261QR1300X	Rural Health Clinic/Center	134	WI

General Provider Information

NPI Number	:	1104162841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILE BLUFF MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	1050 DIVISION ST
Second Line	:
City	:	MAUSTON
State	:	WI
Zip	:	53948-1931
Country	:	US
Telephone Number	:	608-847-6161
Fax Number	:	608-847-2079

Provider Business Practice Location Address
First Line	:	901 W BRIDGE ST
Second Line	:
City	:	NEW LISBON
State	:	WI
Zip	:	53950-1083
Country	:	US
Telephone Number	:	608-847-6161
Fax Number	:	608-847-2079

Authorized Official
Title or Position	:	VP/CFO
Name	:	THOMAS KAMINSKI
Credential	:
Telephone Number	:	608-847-1452

Provider Enumeration Date	:	12/28/2012
Last Update Date	:	04/13/2026

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