Provider Demographics
NPI:1114181344
Name:VERNON COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:VERNON COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RB, BSN
Authorized Official - Phone:608-637-5251
Mailing Address - Street 1:PO BOX 209
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-0209
Mailing Address - Country:US
Mailing Address - Phone:608-637-5251
Mailing Address - Fax:608-637-5514
Practice Address - Street 1:318 FAIRLANE DR
Practice Address - Street 2:CO HWY BB
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-0209
Practice Address - Country:US
Practice Address - Phone:608-637-5251
Practice Address - Fax:608-637-5514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43081000Medicaid
WI44001900Medicaid