Provider Demographics
NPI:1326214768
Name:MEMORIAL HOSPITAL OF LAFAYETTE COUNTY
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF LAFAYETTE COUNTY
Other - Org Name:
Other - Org Type:
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1015207P00000X, 207Q00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32765900Medicaid