Provider Demographics
NPI:1104373885
Name:GUNDERSEN CLINIC LTD
Entity Type:Organization
Organization Name:GUNDERSEN CLINIC LTD
Other - Org Name:GUNDERSEN HEALTHY LIVING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:B
Authorized Official - Last Name:ADANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-775-8025
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:608-775-7440
Practice Address - Street 1:1140 MAIN ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4124
Practice Address - Country:US
Practice Address - Phone:608-782-9622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUNDERSEN CLINIC LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-09
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center