BLACK RIVER MEMORIAL HOSPITAL INC (NPI# 1811940331) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811940331 |
| Entity Type | Organization |
| Organization Name | BLACK RIVER MEMORIAL HOSPITAL INC |
| Practice Address |
711 W Adams St Black River Falls WI 54615-9108 |
| Practice Telephone | 7152845361 |
| Practice Fax Number | 7152841390 |
| Mailing Telephone | 7152845361 |
| Mailing Fax Number | 7152841390 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2013-07-08 |
| Authorized Official Name | MARY BETH WHITE-JACOBS (PRESIDENT & CEO) |
| Authorized Official Telephone | 7152845361 |
| Authorized Official Credential | RN BSN MHA FACHE |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
1037 | WI | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32768200 | 05 | |
| WI | 43417200 | 05 | |
| WI | 41221700 | 05 | |
| WI | 11018300 | 05 | |
| WI | 32946600 | 05 | |
| WI | 11018310 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285782250 | Black River Memorial Hospital Inc | Durable Medical Equipment & Medical Supplies | 311 County Road A Ste 2, Black River Falls, WI 54615-8205 | 2007-01-08 |
| 1063516078 | Black River Memorial Hospital Inc | Hospice Care, Community Based | 311 County Road A Ste 1, Black River Falls, WI 54615-8205 | 2006-09-11 |
| 1215085253 | Black River Memorial Hospital Inc | Home Health | 311 County Road A Ste 1, Black River Falls, WI 54615-8205 | 2007-01-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | BLACK RIVER MEMORIAL HOSPITAL INC | 711 W Adams St, Black River Falls, WI 54615-9108 |
| Street Address |
711 W ADAMS ST |
| City | BLACK RIVER FALLS |
| State | WI |
| Zip Code | 54615-9108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346236478 | Esteban E Miller | Family Medicine | 711 W Adams St, Black River Falls, WI 54615-9108 | 2005-09-23 |
| 1164023941 | Joseph Mcinerney | Physical Therapist | 711 W Adams St, Black River Falls, WI 54615-5052 | 2020-11-06 |
| 1871115485 | Corinne Billet | Social Worker | 711 W Adams St, Black River Falls, WI 54615-5052 | 2020-05-18 |
| 1659843365 | Heather Struensee | Nurse Practitioner | 711 W Adams St, Black River Falls, WI 54615-2200 | 2018-12-19 |
| 1356821490 | Jennifer Christine Hanson | Nurse Practitioner | 711 W Adams St, Black River Falls, WI 54615-9108 | 2018-08-17 |
| 1548788284 | Darin C Lash | Physician Assistant | 711 W Adams St, Black River Falls, WI 54615-2200 | 2017-09-01 |
| 1306372958 | Holly Freeman | Occupational Therapist | 711 W Adams St, Black River Falls, WI 54615-9108 | 2017-05-02 |
| 1205245677 | Nathan A Swan | Physical Therapist | 711 W Adams St, Black River Falls, WI 54615-9108 | 2014-08-10 |
| 1295143394 | Tamara Insteness | Nurse Practitioner | 711 W Adams St, Black River Falls, WI 54615 | 2014-08-01 |
| 1063755171 | Gundersen Lutheran Medical Center Inc | Clinic/Center | 711 W Adams St, Black River Falls, WI 54615-9108 | 2013-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104339118 | Lori Jean Mohring | Counselor | 420 Wi-54, Black River Falls, WI 54615 | 2017-11-13 |
| 1184095788 | Robert Anthony Zupancich | Pharmacist | 611 Hwy 54 East, Black River Falls, WI 54615 | 2015-10-08 |
| 1932545902 | Hera Jane Lonetree-rindahl | Counselor | W9850 Airport Rd, Black River Falls, WI 54615 | 2013-05-17 |
| 1902141344 | Mary Jane Jones | Pharmacist | 610 West Adams St., Black River Falls, WI 54615 | 2012-12-11 |
| 1285905844 | Vera Ellen Heubel | Registered Nurse | N6520 Lumber Jack Guy Road, Black River Falls, WI 54615 | 2012-01-13 |
| 1295048361 | Megan Ryan | Dentist | N6571 Lumberjack Guy Road, Black River Falls, WI 54615 | 2010-07-19 |
| 1912147828 | Evangeline M Suquet | Counselor | W9850 Airport Road, Black River Falls, WI 54615 | 2009-03-05 |
| 1407091192 | Holly Kay Rodenberg | Registered Nurse | N6520 Lumber Jack Guy Rd, Black River Falls, WI 54615 | 2008-12-09 |
| 1841467636 | Pamela Listle | Speech-Language Pathologist | 711 West Adams St., Black River Falls, WI 54615 | 2008-05-12 |
| 1285778969 | Black River Family Dentistry Ltd | Dentist | N6625 County Hwy A, Black River Falls, WI 54615 | 2007-02-16 |
| Find all providers in zip 54615 | ||||
| Taxonomy Code | 282NC0060X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Critical Access |
| Definition to come. |
| Notes: [7/1/2003: new] |
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| 1255662573 | Donald Morris Levy | General Acute Care Hospital | 4348 W Tarrytown Ln, Mequon, WI 53092-4850 | 2010-01-26 |
| 1841483112 | Club Staffing | General Acute Care Hospital | 1082 Vinyard Dr, Oregon, WI 53575-3314 | 2007-08-21 |
| 1104953090 | New Anesthesia | General Acute Care Hospital | 1236 Stillmeadow Ln, Menasha, WI 54952-8920 | 2007-02-27 |
| 1184765240 | Tomah Memorial Hospital Inc | General Acute Care Hospital | 501 Gopher Dr, Tomah, WI 54660-4513 | 2007-02-10 |
| 1194737817 | Chippewa Valley Hospital & Oakview Care Center, Inc. | General Acute Care Hospital | 1220 3rd Ave W, Durand, WI 54736-1600 | 2006-08-12 |
| 1154350049 | Edgerton Hospital and Health Services | General Acute Care Hospital | 11101 N Sherman Rd, Edgerton, WI 53534-9002 | 2006-07-02 |
| 1881640183 | Westfields Hospital, Inc. | General Acute Care Hospital | 535 Hospital Road, New Richmond, WI 54017-1449 | 2006-05-26 |
| 1053362624 | Ripon Medical Center Inc | General Acute Care Hospital | 845 Parkside Street, Ripon, WI 54971-8505 | 2006-05-16 |
| 1255382933 | Cumberland Memorial Hospital | General Acute Care Hospital | 1110 7th Ave, Cumberland, WI 54829-9133 | 2006-05-15 |
| Find all providers with the same taxonomy | ||||
| City | BLACK RIVER FALLS |
| Zip Code | 54615 |
Please comment or provide details below to improve the information on BLACK RIVER MEMORIAL HOSPITAL INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.