GUNDERSEN LUTHERAN MEDICAL CENTER INC

Provider Demographics

• NPI: 1376593442
• Name: GUNDERSEN LUTHERAN MEDICAL CENTER INC
• Entity Type: Organization
• Organization Name: GUNDERSEN LUTHERAN MEDICAL CENTER INC
• Authorized Official - Title/Position: CCO
• Authorized Official - First Name: KARI
• Authorized Official - Middle Name: B
• Authorized Official - Last Name: ADANK
• Authorized Official - Phone: 608-775-8025
• Mailing Address - Street 1: 1910 SOUTH AVE
• Mailing Address - City: LA CROSSE
• Mailing Address - State: WI
• Mailing Address - Zip Code: 54601-5467
• Mailing Address - Country: US
• Mailing Address - Phone: 608-782-7300
• Practice Address - Street 1: 1910 SOUTH AVE
• Practice Address - City: LA CROSSE
• Practice Address - State: WI
• Practice Address - Zip Code: 54601
• Practice Address - Country: US
• Practice Address - Phone: 608-775-4370
• Practice Address - Fax: 608-775-7440
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-05-11
• Last Update Date: 2022-03-25

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital
No	261QE0700X	Ambulatory Health Care Facilities	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment
No	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)
No	291U00000X	Laboratories	Clinical Medical Laboratory
No	324500000X	Residential Treatment Facilities	Substance Abuse Rehabilitation Facility

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WI	11012926	Medicaid
WI	32945900	Medicaid
WI	33072600	Medicaid
MN	419555800	Medicaid
WI	42194300	Medicaid
WI	42220300	Medicaid
WI	42228900	Medicaid
MN	169555000	Medicaid
WI	42051000	Medicaid
IA	0699017	Medicaid
WI	11012900	Medicaid
WI	100020154	Medicaid
WI	42050900	Medicaid
WI	42063400	Medicaid
MN	765347600	Medicaid
WI	42053600	Medicaid
WI	42150400	Medicaid
WI	42212400	Medicaid
WI	44003500	Medicaid
WI	42053600	Medicaid
WI	100020154	Medicaid
WI	42150400	Medicaid
WI	523500	Medicare ID - Type Unspecified	GL DIALYSIS PDC
WI	42053600	Medicaid
WI	42194300	Medicaid
WI	11012926	Medicaid
WI	100020154	Medicaid
WI	42150400	Medicaid