Provider Demographics
NPI:1467640276
Name:MEMORIAL HOSPITAL OF BOSCOBEL
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF BOSCOBEL
Other - Org Name:BOSCOBEL AREA HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT - FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:RALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-250-1194
Mailing Address - Street 1:205 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-1642
Mailing Address - Country:US
Mailing Address - Phone:608-375-6217
Mailing Address - Fax:608-375-5463
Practice Address - Street 1:200 W BLUFF ST
Practice Address - Street 2:
Practice Address - City:BOSCOBEL
Practice Address - State:WI
Practice Address - Zip Code:53805-1601
Practice Address - Country:US
Practice Address - Phone:608-375-2424
Practice Address - Fax:608-375-6285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2706440002Medicare NSC