FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC.

Provider Demographics

• NPI: 1255334173
• Name: FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC.
• Entity type: Organization
• Organization Name: FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC.
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - First Name: AUSTIN
• Authorized Official - Last Name: REEDER
• Authorized Official - Phone: 414-805-2915
• Mailing Address - Street 1: N74 W12501 LEATHERWOOD CT
• Mailing Address - Street 2: WOODLAND PRIME 400, PFS, ATTN: T. LEMMERMANN
• Mailing Address - City: MENOMONEE FALLS
• Mailing Address - State: WI
• Mailing Address - Zip Code: 53051-4490
• Mailing Address - Country: US
• Mailing Address - Phone: 414-777-0417
• Mailing Address - Fax: 414-777-0096
• Practice Address - Street 1: 9200 W WISCONSIN AVE
• Practice Address - City: MILWAUKEE
• Practice Address - State: WI
• Practice Address - Zip Code: 53226-3522
• Practice Address - Country: US
• Practice Address - Phone: 414-805-3000
• Practice Address - Fax: 414-805-7790
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-05-24
• Last Update Date: 2025-04-22

Provider Licenses

State	License ID	Taxonomies
		261QR0200X
WI	232; 279	282N00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282N00000X	Hospitals	General Acute Care Hospital
No	261QR0200X	Ambulatory Health Care Facilities	Clinic/Center	Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	100036370A	Medicaid
WI	501166	Other	DEAN HEALTH PLAN
MI	304656043	Medicaid
MN	923550700	Medicaid
WI	5000021	Other	UNITED HEALTHCARE
WI	11000400	Medicaid
WI	137793700	Other	US DEPT OF LABOR
WI	9000355	Other	TOUCHPOINT
IA	0939538	Medicaid
MI	404656061	Medicaid
MI	304656043	Medicaid
MN	923550700	Medicaid
MS	0095078	Medicaid
WI	11000400	Medicaid
MI	404656061	Medicaid
NV	E61000134	Medicaid
IA	0939538	Medicaid
MI	404656061	Medicaid
IL	=========001	Medicaid
IA	0939538	Medicaid