MEDICARE: UPLAND HILLS HEALTH, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207V00000X	Obstetrics & Gynecology Physician
2	363LF0000X	Family Nurse Practitioner
3	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WI1085	OTHER	WI	MEDICARE PTAN

General Provider Information

NPI Number	:	1356685960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPLAND HILLS HEALTH, INC.

Provider Business Mailing Address
First Line	:	202 W US HIGHWAY 18
Second Line	:
City	:	MONTFORT
State	:	WI
Zip	:	53569-9452
Country	:	US
Telephone Number	:	608-943-6308
Fax Number	:	608-943-8408

Provider Business Practice Location Address
First Line	:	202 W US HIGHWAY 18
Second Line	:
City	:	MONTFORT
State	:	WI
Zip	:	53569-9452
Country	:	US
Telephone Number	:	608-943-6308
Fax Number	:	608-943-8408

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	PHYLLIS A FRITSCH
Credential	:
Telephone Number	:	608-930-8000

Provider Enumeration Date	:	11/20/2012
Last Update Date	:	11/20/2012

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