Organization
LA CROSSE COUNTY CMO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PATRICK KILLEEN (CMO ADMINISTRATOR)
(608) 785-6062
Entity
Organization
Contact information
Practice address
1407 SAINT ANDREW ST STE 100, LA CROSSE, WI 54603-2378
(608) 785-6266
(608) 785-6315
Mailing address
1407 SAINT ANDREW ST STE 100, LA CROSSE, WI 54603-2378
(608) 785-6266
(608) 785-6315
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
69005600
—
WI
Enumeration date
03/12/2007
Last updated
08/22/2020
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