Provider Demographics
NPI:1851534754
Name:MOUNDVIEW MEMORIAL HOSPITAL & CLINICS, INC
Entity Type:Organization
Organization Name:MOUNDVIEW MEMORIAL HOSPITAL & CLINICS, INC
Other - Org Name:GUNDERSEN MOUNDVIEW HOSPITAL AND CLINICS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-339-6814
Mailing Address - Street 1:6501 CITY WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:402 WEST LAKE STREET
Practice Address - Street 2:
Practice Address - City:FRIENDSHIP
Practice Address - State:WI
Practice Address - Zip Code:53934
Practice Address - Country:US
Practice Address - Phone:952-653-2528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNDVIEW MEMORIAL HOSPITAL & CLINICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-08
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site