Organization
GUNDERSEN LUTHERAN MEDICAL CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARI B ADANK (CCO)
(608) 775-8025
Entity
Organization
Contact information
Practice address
1910 SOUTH AVE, LA CROSSE, WI 54601
(608) 775-4370
(608) 775-7440
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
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
282N00000X
General Acute Care Hospital
Primary
—
—
291U00000X
Clinical Medical Laboratory
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0699017
—
IA
05
—
100020154
—
WI
05
—
11012900
—
WI
05
—
11012926
—
WI
05
—
169555000
—
MN
05
—
32945900
—
WI
05
—
33072600
—
WI
05
—
419555800
—
MN
05
—
42050900
—
WI
05
—
42051000
—
WI
05
—
42053600
—
WI
05
—
42063400
—
WI
05
—
42150400
—
WI
05
—
42194300
—
WI
05
—
42212400
—
WI
05
—
42220300
—
WI
05
—
42228900
—
WI
05
—
44003500
—
WI
05
—
765347600
—
MN
Enumeration date
05/11/2006
Last updated
03/25/2022
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