Provider Demographics
NPI:1639733173
Name:LAFAYETTE COUNTY
Entity Type:Organization
Organization Name:LAFAYETTE COUNTY
Other - Org Name:MEMORIAL HOSPITAL OF LAFAYETTE COUNTY PRIMARY CARE CLINIC OF ARGYLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRYLL
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-776-4466
Mailing Address - Street 1:800 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-1228
Mailing Address - Country:US
Mailing Address - Phone:608-776-4466
Mailing Address - Fax:608-776-5806
Practice Address - Street 1:107 CENTER STREET
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:WI
Practice Address - Zip Code:53504
Practice Address - Country:US
Practice Address - Phone:608-543-3392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAFAYETTE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100080843Medicaid