Provider Demographics
NPI:1861829194
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:MR
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 1:402 W LAKE ST
Mailing Address - Street 2:PO BOX 40
Mailing Address - City:FRIENDSHIP
Mailing Address - State:WI
Mailing Address - Zip Code:53934-9699
Mailing Address - Country:US
Mailing Address - Phone:608-339-3331
Mailing Address - Fax:608-339-9385
Practice Address - Street 1:207 N PIONEER PARK RD
Practice Address - Street 2:UNIT 8
Practice Address - City:WESTFIELD
Practice Address - State:WI
Practice Address - Zip Code:53964-9092
Practice Address - Country:US
Practice Address - Phone:608-296-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI107800261Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI521309Medicare Oscar/Certification