Provider Demographics
NPI:1184765240
Name:TOMAH MEMORIAL HOSPITAL INC
Entity type:Organization
Organization Name:TOMAH MEMORIAL HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-372-2181
Mailing Address - Street 1:501 GOPHER DR
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-4513
Mailing Address - Country:US
Mailing Address - Phone:608-372-2181
Mailing Address - Fax:608-377-8637
Practice Address - Street 1:501 GOPHER DR
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-4513
Practice Address - Country:US
Practice Address - Phone:608-372-2181
Practice Address - Fax:608-377-8737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
WI2049-800282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11017810Medicaid
WI521320Medicare PIN
WI52-1320Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WI521320Medicare Oscar/Certification