Provider Demographics
NPI:1124063573
Name:TRI-COUNTY MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:TRI-COUNTY MEMORIAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, REGIONAL
Authorized Official - Prefix:
Authorized Official - First Name:ROXANE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SCHLEICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-775-3839
Mailing Address - Street 1:18601 LINCOLN ST.
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:WI
Mailing Address - Zip Code:54773
Mailing Address - Country:US
Mailing Address - Phone:715-538-4361
Mailing Address - Fax:715-538-2271
Practice Address - Street 1:18601 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:WI
Practice Address - Zip Code:54773-8605
Practice Address - Country:US
Practice Address - Phone:715-538-4361
Practice Address - Fax:715-538-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1019282N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11016000Medicaid
WI11016010Medicaid
WI11016000Medicaid
WI11016010Medicaid