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SCH520109-05 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 / New Lisbon Family Medicine
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH520109-05
Medicare Provider Number
520109
Outpatient Facility Provider Number
528550
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, Inc.
Tom Kaminski, VP / CFO
(715) 935-0499
Primary Contact
Mile Bluff Medical Center
Craig William Griffis, Director of Pharmacy
(608) 847-1255
Addresses
Street Address
901W BRIDGE ST
NEW LISBON, WI 53950-1083
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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