Provider Demographics
NPI:1114987054
Name:LAFAYETTE COUNTY
Entity Type:Organization
Organization Name:LAFAYETTE COUNTY
Other - Org Name:MEMORIAL HOSPITAL OF LAFAYETTE COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:KUEPERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-776-5718
Mailing Address - Street 1:800 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-1228
Mailing Address - Country:US
Mailing Address - Phone:608-776-4466
Mailing Address - Fax:608-776-5701
Practice Address - Street 1:800 CLAY ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-1228
Practice Address - Country:US
Practice Address - Phone:608-776-4466
Practice Address - Fax:608-776-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
WI1015282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32765900Medicaid
WI42060900Medicaid
WI11014810Medicaid
WI3323770Medicaid
WI11014800Medicaid
WI32946300Medicaid
WI41227700Medicaid
WI11014800Medicaid
WI32946300Medicaid