Provider Demographics
NPI:1720147366
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:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:FRIENDSHIP
Mailing Address - State:WI
Mailing Address - Zip Code:53934-0040
Mailing Address - Country:US
Mailing Address - Phone:608-339-3331
Mailing Address - Fax:
Practice Address - Street 1:402 W LAKE ST
Practice Address - Street 2:
Practice Address - City:FRIENDSHIP
Practice Address - State:WI
Practice Address - Zip Code:53934-9699
Practice Address - Country:US
Practice Address - Phone:608-339-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNDVIEW MEMORIAL HOSPITAL & CLINICS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-08
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11012000Medicaid
WICR0660OtherMEDICARE RAILROAD
WICR0660OtherMEDICARE RAILROAD
WI000000504Medicare PIN