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CAH521327-01 WAUPUN MEMORIAL HOSPITAL (Active)
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Main Details
Name
WAUPUN MEMORIAL HOSPITAL
Subdivision Name
Fond du Lac Dialysis
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521327-01
Medicare Provider Number
521327
Outpatient Facility Provider Number
523506
Additional Details
Current Program Status
Active
Registration Date
4/27/2012
Participating Start Date
7/1/2012
Participating Approval Date
5/21/2012
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
SSM Health
Matt Kinsella, Regional Vice President of Finance
(608) 250-1194
Primary Contact
SSM Health
Michelle Nicole Schmitt, Director of Business Operations
(608) 294-6203
Addresses
Street Address
305 Camelot Drive
Fond du Lac, WI 54935
Billing Address
Waupun Memorial Hospital
620 West Brown Street
Waupun, WI 53963
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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