Provider Demographics
NPI:1144226507
Name:VERNON MEMORIAL HEALTHCARE, INC
Entity Type:Organization
Organization Name:VERNON MEMORIAL HEALTHCARE, INC
Other - Org Name:HIRSCH CLINIC - VMH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-637-4796
Mailing Address - Street 1:407 S MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-4000
Mailing Address - Country:US
Mailing Address - Phone:608-637-3174
Mailing Address - Fax:608-638-5038
Practice Address - Street 1:407 S MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1511
Practice Address - Country:US
Practice Address - Phone:608-637-3174
Practice Address - Fax:608-637-3120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERNON MEMORIAL HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-21
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI523996Medicare ID - Type Unspecified