Provider Demographics
NPI:1710180138
Name:TOMAH VA MEDICAL CENTER
Entity Type:Organization
Organization Name:TOMAH VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-374-2807
Mailing Address - Street 1:10222 EMERSON RD
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-4235
Mailing Address - Country:US
Mailing Address - Phone:608-372-3971
Mailing Address - Fax:
Practice Address - Street 1:10222 EMERSON RD
Practice Address - Street 2:500E VETERANS ST
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-4235
Practice Address - Country:US
Practice Address - Phone:608-372-3971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7159273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit