MEDICARE: GUNDERSEN LUTHERAN 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1932826377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUNDERSEN LUTHERAN MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	1910 SOUTH AVE
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-5467
Country	:	US
Telephone Number	:	608-782-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 AVALON COVE CT NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-8498
Country	:	US
Telephone Number	:	608-782-7300
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	KARI B ADANK
Credential	:
Telephone Number	:	608-775-8025

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	10/26/2022

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