Provider Demographics
NPI:1700195542
Name:LADD MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:LADD MEMORIAL HOSPITAL
Other - Org Name:OSCEOLA MEDICAL CENTER SCANDIA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:W
Authorized Official - Last Name:FORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-294-5622
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020-0218
Mailing Address - Country:US
Mailing Address - Phone:715-294-2111
Mailing Address - Fax:715-294-5758
Practice Address - Street 1:21150 OZARK AVE N
Practice Address - Street 2:
Practice Address - City:SCANDIA
Practice Address - State:MN
Practice Address - Zip Code:55073-9447
Practice Address - Country:US
Practice Address - Phone:715-294-2111
Practice Address - Fax:715-294-5758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LADD MEMORIAL HOSPITAL DBA OSCEOLA MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-28
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center