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DSH520087G Gundersen Lutheran Medical Center, Inc. (Terminated)
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Main Details
Name
Gundersen Lutheran Medical Center, Inc.
Subdivision Name
Outpatient AODA Services - Unity House for Women
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520087G
Medicare Provider Number
520087
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/24/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/18/2012
Last Recertification Date
8/8/2014
Termination Date
Termination Reason
7/1/2015
Site closure
Contacts
Authorizing Official
Gundersen Health System, La Crosse, WI
Kay P Marsyla, Director, Reimbursement
(608) 775-0171
Primary Contact
Gundersen Health System
Loren Carrell, Director
(608) 775-6369
Addresses
Street Address
1918-1924 Miller Street
La Crosse, WI 54601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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