Provider Demographics
NPI:1497834550
Name:MINERAL POINT MEDICAL CENTER SC
Entity Type:Organization
Organization Name:MINERAL POINT MEDICAL CENTER SC
Other - Org Name:DODGEVILLE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING DEPT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SLANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-987-2346
Mailing Address - Street 1:104 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MINERAL POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53565-1289
Mailing Address - Country:US
Mailing Address - Phone:608-987-2346
Mailing Address - Fax:608-987-2490
Practice Address - Street 1:1204 JOSEPH ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-9670
Practice Address - Country:US
Practice Address - Phone:608-935-2308
Practice Address - Fax:608-935-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41872200Medicaid
WI41872200Medicaid