Organization Name: | MILE BLUFF MEDICAL CENTER |
NPI Number: | 1427413483 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TIMOTHY BJELLAND (VP, CMO) |
Mailing Address: | 901 W Bridge St New Lisbon |
State: | WI US |
Postal Code: | 539501083 |
Phone Number: | 6085623111 |
Fax Number: | |
NPI Enumeration Date: | 12/17/2015 |
NPI Last Update Date: | 12/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 6726-33 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |