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CAH521327-03 WAUPUN MEMORIAL HOSPITAL (Active)
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Main Details
Name
WAUPUN MEMORIAL HOSPITAL
Subdivision Name
Beaver Dam Dialysis
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH521327-03
Medicare Provider Number
521327
Outpatient Facility Provider Number
523531
Additional Details
Current Program Status
Active
Registration Date
1/3/2013
Participating Start Date
4/1/2013
Participating Approval Date
1/7/2013
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
2100 Kellom Rd Unit A
Beaver Dam, WI 53916
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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