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DSH520087AA Gundersen Lutheran Medical Center, Inc. (Terminated)
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Main Details
Name
Gundersen Lutheran Medical Center, Inc.
Subdivision Name
Main Clinic - Center for Breast Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520087AA
Medicare Provider Number
520087
Outpatient Facility Provider Number
520087
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/9/2014
Last Recertification Date
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
1836 South Ave
La Crosse, WI 54601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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