Provider Demographics
NPI:1760808968
Name:PRAIRIE DU CHIEN MEMORIAL HOSPITAL ASSOC INC
Entity Type:Organization
Organization Name:PRAIRIE DU CHIEN MEMORIAL HOSPITAL ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-357-2000
Mailing Address - Street 1:1800 BRONSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FENNIMORE
Mailing Address - State:WI
Mailing Address - Zip Code:53809-9778
Mailing Address - Country:US
Mailing Address - Phone:608-822-2940
Mailing Address - Fax:608-357-2254
Practice Address - Street 1:1800 BRONSON BLVD
Practice Address - Street 2:
Practice Address - City:FENNIMORE
Practice Address - State:WI
Practice Address - Zip Code:53809-9778
Practice Address - Country:US
Practice Address - Phone:608-822-2940
Practice Address - Fax:608-822-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIHSAT-7QXLRW207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1619024197Medicaid
IA1619024197Medicaid
WI521330Medicare Oscar/Certification