Organization
PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN A EDWARDS (CEO)
(262) 928-2263
Entity
Organization
Contact information
Practice address
791 SUMMIT AVE, OCONOMOWOC, WI 53066
(262) 928-2510
(262) 928-4032
Mailing address
791 SUMMIT AVE, OCONOMOWOC, WI 53066-3844
(262) 928-2510
(262) 928-4032
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
113
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11011100
—
WI
Enumeration date
01/06/2006
Last updated
05/06/2020
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