Provider Demographics
NPI:1609822881
Name:COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC
Other - Org Name:FROEDTERT MENOMONEE FALLS HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUX
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:262-257-3019
Mailing Address - Street 1:N74 W12501 LEATHERWOOD CT
Mailing Address - Street 2:400 WOODLAND PRIME, SUITE 103
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4490
Mailing Address - Country:US
Mailing Address - Phone:414-777-0417
Mailing Address - Fax:414-777-0096
Practice Address - Street 1:W180N8085 TOWN HALL RD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3518
Practice Address - Country:US
Practice Address - Phone:262-251-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI400800282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40418300Medicaid
WI11014300Medicaid
WI40418300Medicaid
WI11014300Medicaid