MEDICARE: TRI-COUNTY MEMORIAL HOSPITAL, 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		WI

General Provider Information

NPI Number	:	1659625192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-COUNTY MEMORIAL HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	18601 LINCOLN ST
Second Line	:
City	:	WHITEHALL
State	:	WI
Zip	:	54773-8605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 S PETERSON AVE
Second Line	:
City	:	BLAIR
State	:	WI
Zip	:	54616-8861
Country	:	US
Telephone Number	:	608-989-2505
Fax Number	:	608-989-9844

Authorized Official
Title or Position	:	CFO, REGIONAL
Name	:	ROXANE KAY SCHLEICH
Credential	:
Telephone Number	:	608-775-3839

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	11/03/2018

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