Provider Demographics
NPI:1912290651
Name:VERNON MEMORIAL HOSPITAL ASSN
Entity Type:Organization
Organization Name:VERNON MEMORIAL HOSPITAL ASSN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-637-4796
Mailing Address - Street 1:407 S MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-4004
Mailing Address - Country:US
Mailing Address - Phone:608-637-4718
Mailing Address - Fax:608-637-4719
Practice Address - Street 1:507 S MAIN ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-2059
Practice Address - Country:US
Practice Address - Phone:608-637-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERNON MEMORIAL HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-26
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site