Provider Demographics
NPI:1114015492
Name:HILTON MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:HILTON MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STADTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-785-0390
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54602-0055
Mailing Address - Country:US
Mailing Address - Phone:608-785-0390
Mailing Address - Fax:608-785-0323
Practice Address - Street 1:414 3RD ST S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4016
Practice Address - Country:US
Practice Address - Phone:608-785-0390
Practice Address - Fax:608-785-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41647900Medicaid
WI41647900Medicaid
WI=========014OtherBCBS OF WI