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CAH521305-02 MCHS-FRANCISCAN SPARTA (Active)
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Main Details
Name
MCHS-FRANCISCAN SPARTA
Subdivision Name
Prairie du Chien Clinic - Obstetrics and Gynecology
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521305-02
Medicare Provider Number
521305
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/8/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/17/2024
Last Recertification Date
Contacts
Authorizing Official
Mayo Clinic Health System
Tanner Holst, Regional Chair-Administration SWWI
(608) 392-9705
Primary Contact
Mayo Clinic Health System
Matt Lemin, Program Manager
(507) 293-3853
Addresses
Street Address
800 E Blackhawk Ave
Prairie du Chien, WI 53821
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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