Provider Demographics
NPI:1710970041
Name:COUNTY OF RUSK
Entity Type:Organization
Organization Name:COUNTY OF RUSK
Other - Org Name:RUSK COUNTY MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARISSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-532-5561
Mailing Address - Street 1:900 COLLEGE AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:LADYSMITH
Mailing Address - State:WI
Mailing Address - Zip Code:54848-2116
Mailing Address - Country:US
Mailing Address - Phone:715-532-5561
Mailing Address - Fax:715-532-3025
Practice Address - Street 1:900 COLLEGE AVENUE WEST
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-2116
Practice Address - Country:US
Practice Address - Phone:715-532-5561
Practice Address - Fax:715-532-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1030282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11009310Medicaid
WI33114700Medicaid
WI11009300Medicaid
WI43410200Medicaid
WI32766700Medicaid
WI11009300Medicaid
WI11009310Medicaid
WI52Z328Medicare Oscar/Certification