Organization
GUNDERSEN LUTHERAN MEDICAL CENTER INC
Active
Parent organization
GUNDERSEN LUTHERAN MEDICAL CENTER INC
Other names
GLMC BLACK RIVER FALLS RENAL DIALYSIS
Organization subpart
Yes
Provider details
NPI number
Legal business name
GUNDERSEN LUTHERAN MEDICAL CENTER INC
Authorized official
KARI B ADANK (CCO)
(608) 775-8025
Entity
Organization
Contact information
Practice address
711 W ADAMS ST, BLACK RIVER FALLS, WI 54615-9108
(608) 782-7300
Mailing address
1910 SOUTH AVE, LA CROSSE, WI 54601-5467
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42063500
—
WI
Enumeration date
03/27/2013
Last updated
03/25/2022
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