Provider Demographics
NPI:1851345268
Name:AMERY REGIONAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:AMERY REGIONAL MEDICAL CENTER, INC.
Other - Org Name:AMERY HOSPITAL & CLINIC - LUCK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:715-268-8000
Mailing Address - Street 1:265 GRIFFIN ST E
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1439
Mailing Address - Country:US
Mailing Address - Phone:715-268-8000
Mailing Address - Fax:715-268-0311
Practice Address - Street 1:137 FIRST AVE
Practice Address - Street 2:
Practice Address - City:LUCK
Practice Address - State:WI
Practice Address - Zip Code:54853-9057
Practice Address - Country:US
Practice Address - Phone:715-472-2177
Practice Address - Fax:715-472-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
WI528515261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI521308OtherNON-RHC MC PROV
WI32832000Medicaid
WI43060600Medicaid
WI32832000Medicaid
WI521308Medicare ID - Type UnspecifiedNON-RHC MC PROVIDER NO.