Provider Demographics
NPI:1730281866
Name:COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS, INC.
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BESTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-257-3701
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53052-0408
Mailing Address - Country:US
Mailing Address - Phone:262-257-3839
Mailing Address - Fax:262-253-7169
Practice Address - Street 1:W180N8085 TOWN HALL ROAD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-0408
Practice Address - Country:US
Practice Address - Phone:262-251-1000
Practice Address - Fax:262-253-7165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI400-800291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32948900Medicaid