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SCH520109-04 MILE BLUFF MEDICAL CENTER INC. (Active)
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Main Details
Name
MILE BLUFF MEDICAL CENTER INC.
Subdivision Name
MILE BLUFF MEDICAL CENTER INC / Mile Bluff Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH520109-04
Medicare Provider Number
520109
Outpatient Facility Provider Number
528549
Additional Details
Current Program Status
Active
Registration Date
1/6/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/16/2016
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Mile Bluff Medical Center
Dara Beth Bartels, Chief Executive Officer
(608) 847-2992
Primary Contact
Mile Bluff Medical Center
Craig William Griffis, Director of Pharmacy
(608) 847-1255
Addresses
Street Address
1040 DIVISION ST
MAUSTON, WI 53948-1931
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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