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DSH520087H Gundersen Lutheran Medical Center, Inc. (Terminated)
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Main Details
Name
Gundersen Lutheran Medical Center, Inc.
Subdivision Name
Unity House for Men
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520087H
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
1312 5th Avenue South
La Crosse, WI 54601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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