Provider Demographics
NPI:1417201864
Name:TRI-COUNTY MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:TRI-COUNTY MEMORIAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, REGIONAL
Authorized Official - Prefix:
Authorized Official - First Name:ROXANE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SCHLEICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-775-3839
Mailing Address - Street 1:18601 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773-8605
Mailing Address - Country:US
Mailing Address - Phone:715-538-4361
Mailing Address - Fax:715-538-2271
Practice Address - Street 1:18606 ERVIN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-8613
Practice Address - Country:US
Practice Address - Phone:715-538-4355
Practice Address - Fax:715-538-2151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-COUNTY MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-07
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI52-3868OtherPTAN