Provider Demographics
NPI:1427413483
Name:MILE BLUFF MEDICAL CENTER
Entity Type:Organization
Organization Name:MILE BLUFF MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BJELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:608-847-9826
Mailing Address - Street 1:901 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW LISBON
Mailing Address - State:WI
Mailing Address - Zip Code:53950-1083
Mailing Address - Country:US
Mailing Address - Phone:608-562-3111
Mailing Address - Fax:
Practice Address - Street 1:901 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW LISBON
Practice Address - State:WI
Practice Address - Zip Code:53950-1083
Practice Address - Country:US
Practice Address - Phone:608-562-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6726-33261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care