Provider Demographics
NPI:1497750921
Name:VERNON MEMORIAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:VERNON MEMORIAL HEALTHCARE, INC.
Other - Org Name:VERNON MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-637-4796
Mailing Address - Street 1:507 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-2059
Mailing Address - Country:US
Mailing Address - Phone:608-637-2101
Mailing Address - Fax:608-637-2141
Practice Address - Street 1:507 S MAIN ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-2059
Practice Address - Country:US
Practice Address - Phone:608-637-2101
Practice Address - Fax:608-637-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1053282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI521348Medicare ID - Type Unspecified