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DSH520087CK Gundersen Lutheran Medical Center, Inc. (Active)
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Main Details
Name
Gundersen Lutheran Medical Center, Inc.
Subdivision Name
Hospice Home
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH520087CK
Medicare Provider Number
520087
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/10/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/15/2015
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Gundersen Health system
Michelle Micka, VP Finance
(608) 775-3131 Ext: 53131
Primary Contact
Gundersen Health System
Loren Carrell, Director
(608) 775-6369
Addresses
Street Address
724 Denton
La Crosse, WI 54601
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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