Provider Demographics
NPI:1780780171
Name:BETHANY ST JOSEPH CORPORATION
Entity type:Organization
Organization Name:BETHANY ST JOSEPH CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSKOPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-788-5700
Mailing Address - Street 1:2501 SHELBY RD
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-8037
Mailing Address - Country:US
Mailing Address - Phone:608-788-5700
Mailing Address - Fax:608-788-4030
Practice Address - Street 1:2501 SHELBY RD
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-8037
Practice Address - Country:US
Practice Address - Phone:608-788-5700
Practice Address - Fax:608-788-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0475040001Medicare NSC